I have a number of patients who are not able to afford private treatments or investigations. I always work closely with their GP and any specialists to get as much done as possible through the NHS. I remain in contact with patients following the initial assessment with the aim of assisting them through similar issues to those raised in the review. I accept that sometimes it is not possible to get the treatment locally (because of lack of local expertise). I and many of my colleagues in the field continue to raise awareness among clinicians, commissioners, and politicians about these concerns. While I fully understand any frustrations a person may have, I am not in control of the system. The feedback here should primarily be about me and not about issues in the NHS that I have no control over. As such I am disappointed that with regards to 'Trust' and 'Listening' at least the reviewer has given me the score they have, as I endeavour to do all that is within my control to help my patients. Many will come seeking a diagnosis and support. Many have a diagnosis and are seeking further advice. It is very rarely the case that I cannot help at least in some way, and if I cannot help I am completely honest about that. Also, despite our treatments some people do not get better. We recognize and understand that. It is a fact in many areas of medicine. I am not aware of who the reviewer is and would encourage them to contact me if they are struggling to move their care forward.