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Neurology services not meeting patients’ needs

Call for better integration between GPs and hospitals on neurology

Adrian O'Dowd

Tuesday, 07 June 2011

GPs need to work more closely with hospitals to help patients with neurological conditions, claims a report published today.

The report Local adult neurology services for the next decade says that patients with neurological conditions are being let down by the NHS which is not meeting their needs sufficiently.

The joint report from the Royal College of Physicians (RCP) and the Association of British Neurologists says that overall, services for these patients are poorly organised and local hospitals in particular are lacking neurologists.

Neurological disorders are common and account for about one in ten GP consultations, 10% of emergency medical admissions (excluding stroke), and result in disability in one in 50 people in the UK.

The report authors said that these patients needed a range of neurology services at different stages of their illness – acute admission, outpatient care and long-term care – but these were currently poorly organised and badly integrated. This left some patients unable to access the right specialist at the right time and often not near their home.

Neurology services in the UK have mainly developed around large regional neurosciences centres with an emphasis on research and academic excellence, says the report. 

Although they have produced world-class research and new treatments for patients, local district general hospital (DGH) services have suffered particularly due to a lack of local neurologists.

The authors said the lack of local neurologists has resulted in poor local services made worse by an unplanned increase in outpatient demand with inadequate resources and poorly structured services, particularly for patients with chronic neurological diseases.

Services for patients admitted to hospital with an acute neurological illness were particularly worrying because they were rarely provided by neurologists, in contrast to those for stroke and other acute medical emergencies, where the patient sees the right specialist without delay.

The authors makes several recommendations including better integration between primary, secondary and tertiary resources to lead to better neurology networks that are easily accessible, provide local care and, when necessary, involve the regional neurosciences centre.

There should also be more organised care for patients with long-term neurological conditions, managed in part through an enhanced role for GPs and specialist nurses with a special interest in neurology.

Better local planning of services with increased clinical involvement within a commissioner/provider forum, is called for to help create a neurological network to improve clinical outcomes and better value for money.

Dr David Bateman, chair of the working party, said: “The recommendations when implemented will substantially improve local services: many can be achieved at little extra cost mainly by reorganisation of services. The DH and commissioners cannot afford to ignore this report.”

Dr Steve Pollock, vice-chair of the working party, said: “At their best UK neurological services lead the world, but, too often, local hospital and community provision does not meet the patients’ needs, being patchy, inefficient and poor value for money. This report shows how all services can be brought up to the level of the best.”

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