An Extended Scope Practitoner Physiotherapist (ESP) developed a problem shoulder clinic to support the physiotherapy management of patients with shoulder pathology across one healthcare trust. The impact of the clinic on the management of patients and their onward referral to a shoulder surgeon was evaluated. Physiotherapists had access to a problem shoulder clinic that was managed by an ESP with a special interest in shoulders. The clinic provided assessment and advice on the management of patients with shoulder pathology who were receiving physiotherapy treatment. Throughout a three-year period the opinion of the ESP was sought on 256 patients. 69 patients were seen in a face-to-face consultation, the remainder were diuscussed with their treating physiotherapist and advice was offered. 211 patients were managed and discharged through the physiotherapy service. The ESP referred 45 patients to the shoulder surgeon, of which 53% underwent surgery; 20% are awaiting investigations, 22% were managed with injection therapy and five per cent were discharged. The problem shoulder clinic was shown to be a valuable addition to the clinical mentoring system in physiotherapy. It proved to be an important gate-keeping mechanism between physiotherapy and consultant care as 82% of patients referred to the clinic were managed within physiotherapy. The clinic also proved to be an effective means of identifying patients requiring surgery. Of those that were referred to the shoulder surgeon only five per cent were discharged with no further intervention. A planned development as a consequence of this evaluation is a physiotherapy advocate for shoulders for each outlying hospital within the trust. The aim of this will be to strengthen communication links between the shoulder surgeon and physiotherapy departments over a wide geographic area and to facilitate prompt identification of patients in need of referral to the shoulder surgeon.