Our large district general hospital organized additional Waiting List Initiative clinics for paediatric orthopaedic referrals. A prospective audit examined pathology, investigations and disposal, and the implications of Waiting List Initiative clinics, particularly the increased workload for other specialties and disciplines. Variations of normal development were the most common presenting complaints, with the majority discharged following initial consultation. Local protocols, providing guidance to primary care physicians, covered common paediatric orthopaedic problems. We compared these guidelines with the referrals received to establish the referral quality and quantify the extra work generated. Few examples of inappropriate referrals were found, suggesting that referring physicians utilize the guidelines.