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To reduce waiting times and costs, a specially trained physiotherapist was employed to review 100 patients with back pain referred by general practitioners (GPs) to a spinal clinic; 78% proved to have a spinal disorder. Only 24% of the original referrals needed to see the surgeon, with 76% being successfully managed by the physiotherapist. Six per cent of referrals were deemed inappropriate and 16% of patients failed to attend. To evaluate the physio-therapist's assessments each case was discussed with the consultant surgeon, and the appropriateness of the management of each patient was similarly investigated. With appropriate training and a good working relationship with the surgeon, a chartered physiotherapist can successfully screen patients in a low back pain clinic, such that the efficiency of the unit is improved by improving the throughput whilst maintaining the same standard of care.