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Just had a patient slam out because I have said that I do not think his ankle requires physio. (Turned it over yesterday, minimal bruising and swelling, walking normally, needing no analgesia). He insists that as he belongs to a scheme that he is entitled to use it on each and every occasion that he wishes (several previous referrals). I feel I have a duty to refer only if I think it appropriate, not on demand, and that is why BUPA have told him to ask me for a referral. I have said that I am happy to discuss it with BUPA if they care to phone me. He is quite sure that if he asked the physio if it needed physio he would say yes. I agree that he would!, and BUPA know that, and that's why they ask him to see me first rather than self-refer. What do you think? Mike