Dr Peter Hawker: 'patients are in distress'

It suggests that up to a quarter of all tonsil removal operations on children may be pointless.

But surgeons' leaders say it is still difficult to distinguish between those who genuinely need the operations and those who could be treated in easier ways.

The government report suggests that up to 20,000 children are undergoing tonsilectomies when their recurrent infections would be better treated by antibiotics.

A tonsilectomy, while a comparatively minor operation, still carries some risk, and certainly is painful for the child.

The Department of Health also suggests that a third of the annual 330,000 people who are referred to orthopaedic specialists with back pain would be served better by referrals to physiotherapists.

The report also questions operations to remove wisdom teeth - there are 100,000 such operations every year in the NHS.

"More awareness"

However, Dr Peter Hawker, chairman of the British Medical Association's consultants' committee, told the BBC that weeding out the quarter of patients was not always easy.

Dr Peter Hawker says it is hard to spot those who do not need surgery

He said: "One of the problems we have - when you're sitting in front of a patient who may be distressed, having recurrent infections, you have to apply that statistic to the individual patient.

"Most of my colleagues now are beginning to become aware of the evidence that is coming through."

Tonsilectomy, referral for back pain, and the removal of wisdom teeth are three topics which are under examination by the National Institute for Clinical Excellence, a government body set up to advise the NHS on the best, most effective treatments.

Dr Hawker said he hoped that guidance would be forthcoming so that high standards could be achieved across the country.

On the issue of back pain, he agreed that physiotherapist might be better as a first port of call for sufferers.