The article discusses the influence of the Royal College of Radiologists' guidelines on referral practices from general practice. The authors argue that the study design is flawed, as it lacks a control group to account for secular trends and potential variations in practices without education or communication with general practitioners. They suggest that the observed reduction in referrals may not be solely due to the guidelines and propose that a control group could help identify such variations. The authors also note that their practice showed a reduction in referrals for X-ray examinations, which could be a national trend, suggesting that the guidelines' impact may be less pronounced than reported.The article discusses the influence of the Royal College of Radiologists' guidelines on referral practices from general practice. The authors argue that the study design is flawed, as it lacks a control group to account for secular trends and potential variations in practices without education or communication with general practitioners. They suggest that the observed reduction in referrals may not be solely due to the guidelines and propose that a control group could help identify such variations. The authors also note that their practice showed a reduction in referrals for X-ray examinations, which could be a national trend, suggesting that the guidelines' impact may be less pronounced than reported.