‘Neurology services not meeting patients’ needs’, Royal College of Physicians, 7 June 2011

From the Royal College of Physicians' website, 7 June 2011.

A new report from the Royal College of Physicians and the Association of British Neurologists says that overall, services for patients with neurological conditions are poorly organised, and do not meet patients’ needs.

Neurological disorders are very common, accounting 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. They include many different conditions, some very common, such as headache, migraine, epilepsy, Parkinson’s disease and multiple sclerosis, and some rare diseases such as motor neurone disease, myasthenia, and muscular dystrophies.

Patients need a range of neurology services at different stages of their illness – acute admission, outpatient care and long-term care. However, these are currently poorly organised and badly integrated, leaving many patients unable to access the right specialist at the right time and often far from home.

Neurology services in the UK have mainly developed around large regional neurosciences centres with an emphasis on research and academic excellence.  Whilst 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 in contrast to the USA and Europe where there are far more neurologists per head of the population (1:40k versus 1:125K). The lack of local neurologists in the DGH has resulted in poor local services exacerbated by an unplanned increase in outpatient demand driven by waiting time targets, with inadequate resources and poorly structured services, particularly for patients with chronic neurological diseases.

Shortage specialty

Services for patients admitted to hospital with an acute neurological illness are particularly worrying because they are rarely provided by neurologists, in contrast to those for stroke and other acute medical emergencies, where the patient sees the right specialist without delay. This may result in neurology patients not receiving the best care possible. Neurology remains a shortage specialty, with appointments mainly to the regional neurosciences centres and an inequality of more than three to one in numbers of neurologists in different parts of the UK.

To solve these problems the report recommends better integrated primary, secondary and tertiary resources to achieve a neurology network that is easily accessible, provides local care where appropriate and, when necessary, involves the regional neurosciences centre.  The report makes a series of proposals covering acute neurology services, outpatient care, care for patients with long-term neurological conditions, the relationship between local services and the regional centres, commissioning, workforce planning and training.

The three most important proposals are:

• An expansion and improvement of local services with a shift in emphasis from scheduled to emergency care

• Organised care for patients with long-term neurological conditions, managed in part through an enhanced role for specialist nurses and general practitioners with a special interest in neurology

• Better local planning of services with increased clinical involvement within a commissioner/provider forum, creating a neurological network to improve clinical outcomes and better value for money

Many of the practical recommendations are cost-neutral, and can simply be achieved through more efficient working and better use of existing resources. A significant increase in the number of neurologists will be needed over the next decade to meet increased patient expectations.

Dr David Bateman, chair of the working party, said:

‘This important new report on improving neurology services is much needed. It has been produced by the two major medical organisations concerned with neurology services and standards of care for patients, the RCP and ABN, and is fully endorsed by the neurology charities. It is evidence based as far as possible and takes account of patients’ needs. 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:

‘Problems of the nervous system are extremely common.  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 and although investment over the next decade will be necessary, the political will of government, NHS management and clinicians to improve the current unsatisfactory position is more important than finance.'

Steve Ford, Chair of the Neurological Alliance, said:

‘A significant number of neurological charities and patients contributed their experiences and views to this report. Patients with neurological conditions need to see the right specialist at the right time in the right place, but their evidence shows clearly that this isn’t happening due to poorly organised services and not enough specialist care.  We welcome the report’s timely publication and call on the government, at this important time of NHS reform, to place neurology at the top of its agenda.'