We reviewed hospital case notes of all incident cases of intracerebral tumours in SE Scotland to analyse referral pattern and time intervals between presentation, diagnosis and treatment. We identified 439 new patients with intracerebral tumours in a two year period: 64% single (primary brain tumours 43%: metastasis 21%) and 36% multiple (metastases). Ninety-two per cent of patients were referred by GP's and 88% were self referrals to hospital or were initially identified at hospital follow-up clinics. Only 27% of patients were initially referred to the specialist centre (Western General Hospital) but 57% were CT scanned at the specialist centre and 83% were referred to there at some time. Time from GP referral to CT scan was related to availability of local CT scanning. Only 10% of cases with probable single metastases and 39% with HGG were treated with surgery plus radiation. Cranial irradiation was started within four weeks of CT diagnosis in 79% of those with metastases but in less than 5% of patients with HGG. The patterns of care for patients with brain tumours show great variation. Hospital referral guidelines, better inter-hospital and inter-department communications and more available access to CT scanning and radiotherapy should improve the quality of care and possibly treatment outcome in this group of patients.