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The paper by Kamat and Parker 1 in this issue of the Journal raises some important issues about health services use and access in New Zealand. This research, completed by a neurosurgical registrar and a neurosurgeon, highlights large increases in primary care referrals to the Wellington Regional Hospital neurosurgical service. Only a very small percentage of these referrals resulted in a neurosurgical intervention. The authors have valid concerns about the impact this is having on an important tertiary service. They will not be alone in expressing such concerns, with many secondary and tertiary services struggling to meet growing demand. The authors advocate for referral guidelines or pathways, better neurosurgical education in the undergraduate years and better access to complex diagnostic investigations for primary care, in order to stem this growth.

Guest Editorial: General practitioners gatekeepers for referral but neurosurgeons gatekeepers for investigations