Neurology as a collective entity needs to brand itself more successfully.
This was a common theme that came out of a lively panel discussion that took place at the recent Primary Care Neurology Society (P-CNS) conference on ‘Providing Neurology Services in Primary Care’. Held on the 23rd April in London, this one day event showcased how primary care is taking a much more active role in delivering effective neurology services. Representatives from all over the UK gave their perspectives on how to enhance local neurology services and provide greater integration between primary and secondary care.
Lesslie Young, Chief Executive of Epilepsy Scotland was the first speaker of the day and gave a very thorough overview of what can be done when the NHS, third sector and industry come together with a shared aim to enhance local epilepsy services, under the governance of the NHS Joint Working Initiative.
Dr. Greg Rogers, the recently appointed Royal College for General Practitioners (RCGP) clinical champion for epilepsy drew attention to the recent Epilepsy Action document “A Critical Time” highlighting epilepsy service gaps resulting in poor outcomes. Dr. Rogers asked for suggestions to take back to RCGP to help improve epilepsy in primary care and was not disappointed by the audience suggestions. Issues that were raised included education platforms for both patients and clinicians, the sharing of best practice and audit.
Dr. Andy Dowson, chair of the P-CNS, and Director of Headache Services at Kings, and Clinical Lead for East Kent Headache Service, covered how his headache service in Kent works collaboratively with primary care, secondary care and commissioners to enable headache to be treated safely in the community as well as playing an active role in facilitating training. He also highlighted the development of a new GP lead ‘MRI for headache’ service that is being piloted in West Norfolk. One of the aims of the pilot is to monitor the impact of providing GPs with a pathway and referral criteria, enabling a significant proportion of patients with chronic headache to be managed safely in the community1,2,3.
Pam Morris, Nurse Consultant in Epilepsy Service Development from Manchester, covered the positive elements of a community epilepsy service. This included enhanced patient support as well as efficiencies they can deliver such as reducing prescribing costs, encouraging self-management and the use of electronic patient records.
Jane Bradshaw, Neurology Specialist Nurse, from Norfolk Community Health and Care NHS Trust, continued the theme of the benefits of community based nurses and posed the question “What does it mean to have a neurology specialist nurse as opposed to a disease specific nurse?”. She highlighted how the patient voice should be used more effectively with regards to commissioning community based neurology services and also brought to attention the Royal College of Nursing publication Specialist nurses – Changing Lives, saving money. After the presentation, Dr. Enevoldson, Medical Director at Walton Centre NHS Foundation Trust commented that The Walton Centre regard community based neurology nurses as increasingly important in the design of effective, patient focussed neurology services.
With regards to the complexities of the Parkinson’s Disease pathway Dr. Beverly Castleton covered the issues that PD services currently face and again re-iterated the theme that patients should be listened to and their requests actioned. Dr. Castleton addressed who the key players were in running a local PD service and the importance of having one clear pathway – integrated care is essential, location is not as important as access to skills to make services as cost effective as possible.
Dr. Jeremy Brown gave a comprehensive overview of dementia diagnostic tools and how they can be utilised and applied in primary care. He also covered the new Test Your Memory (TYM) test that evaluates cognitive ability, which can be self-administered and appears to be faster and more accurate than current tests in detecting early dementia. Dr. Brown underlined that the questionnaire requires formal validation in primary care, although it has been validated in a secondary care setting4. It still must be interpreted by medical professionals but could be useful in identifying people who need further evaluation.
To complete the showcasing of services, Dr. Stephen Lawrence RCGP Clinical Champion for Diabetes gave an enlightening presentation on how primary care neurology could learn from the significant advances that have been made in primary care diabetes over the past decade. The comparison was made between the growing demands on neurology services and the demands that were evident a few years ago for diabetes. He presented how in an environment of competing priorities, a focus on communicating what can be achieved and what the ‘wins’ will be to each stakeholder is paramount.
The final part of the conference saw a lively panel-led discussion around the future of neurology services that involved a number of neurology specialists from both a clinical, commissioning and third sector background. A common theme that prevailed was that neurology as a collective entity needs to brand itself more successfully and there was agreement that collaboration between the NHS, third sector and industry would be necessary to make this happen and ultimately improve services for patients.
The conference had provided a great platform for discussion, debate and networking that should continue into the future as the NHS evolves.
References
- Taylor et al. Primary care direct access MRI for the investigation of chronic headache. Clinical Radiology 67 24-27, 2012
- Kernick D, Williams S. Should GPs have direct access to neuroradiological investigation when adults present with headache. British Journal of General Practice 2011;61:409-411.
- Kernick D, Ahmed F, Bahra A, et al. Imaging patients with suspected brain tumour. Guidance for primary care. British Journal of General Practice 2008;58(557):880-5.
- Self-administered cognitive screening test (TYM) for detection of Alzheimer’s disease: cross sectional study. BMJ 2009;338:b2030.
