North London Partners in health and care

Neurology services under review

The North Central London STP Neurology Transformation Group has come together to review current neurology services in north central London (NCL) and identify ways of improving the care that patients receive. 

The group is led by Dr Chris Turner, Consultant Neurologist at National Hospital for Neurology and Neurosurgery, and Dr Nick Dattani, GP at Millway Practice and Barnet CCG Governing body member. The group involves neurology consultants and GP representatives from across NCL working together to identify problems and find solutions; consider best practice; review the latest evidence and see what has worked well nationally. 

Current problems that have been identified are: 

  • very long waits for those who need to see a neurologist
  • multiple appointments that could be reduced saving patients time and making better use of scarce resources
  • a short consultation time leading to lack of confidence amongst some GPs in dealing with neurology problems 

One of the first things the group looked at was why patients are referred to a neurologist in the first place, and was there an alternative?  In a typical year there are 13,000 neurology outpatient referrals across NCL, most coming from the patients’ GPs with over 65% being for headaches, dizzy spells, faints and fits.  It was agreed that many of these patients could be managed in primary care by their GP, if the GP had the right support to do so.  

The group has therefore been focusing, over the last few months, on the development of primary care pathways that can act as a guide for GPs in the management of patients with more straightforward conditions.  GPs from all CCGs have had input into the pathways, as well as a wide range of consultant neurologists from National Hospital for Neurology and Neurosurgery,  Queen Square, and The Royal Free.   These new pathways draw on the latest evidence, best practice and will really help GPs to manage some of these patients in their own practice, only referring those who really need specialist opinion.  

In addition, a telephone helpline for GPs is being piloted, planned for May this year, where GPs can seek advice from a consultant neurologist in real time. Sometimes GPs feel that they have no option but to send a patient to A&E or refer them urgently. Evidence demonstrates that some real time advice from a specialist could avoid this.  This idea is drawing on a very successful NHS England project in Liverpool and we are adopting lessons learnt from that to maximise the success and impact of this initiative. 

Moving forward, the medium-term goals are to have standardised treatment pathways in secondary care so that patients will receive the same high standard of evidence based care wherever they are seen, right through from presentation to their GP, to eventual discharge from secondary care.  

In addition, an increase in neurology specialist services supporting A&E departments is being trialled. A&E departments receive a high volume of patients with neurological problems and if they are reviewed by the acute neurology team early in their patient pathway, it can lead to a reduction in bed stay; a reduction in admissions; improved patient diagnosis and management and an enhanced patient experience.                                            

The primary care pathways are being launched in April 2019.

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