Tonsillectomy is a commonly performed operation in children. Although the justification for this procedure has been debatable in the past, more rigorous criteria in defining the need for tonsillectomies are becoming established. The role of the primary care physician in the management of tonsillar disease in children is important as the decision to refer a child for tonsillectomy is made by the general practitioner. A questionnaire survey of 400 general practitioners (GPs) and 31 consultant ENT surgeons was carried out to establish the important criteria used in deciding the need for paediatric tonsillectomy. We found that in general there was a good correlation between GP and Consultant indications for tonsillectomy. However there were two important areas of difference, while most of the GPs felt that recurrent ear infections and 'glue ear' were important indications for tonsillectomy, Consultants did not. Therefore we must be aware of the current recommendations for tonsillectomy and inform present and future GPs.