Primary concerns

Alex Massey says patients with neurological problems need better care pathways in primary care settings.

A report by the Neurological Alliance has found that GPs in England lack confidence in the primary care pathway for people with neurological conditions. The report shows that GPs report having low levels of confidence in the ability of local services and systems to manage patients with neurological problems effectively, and widespread concerns over unnecessary delays. It also suggests GPs feel they would benefit from more support to manage people presenting with suspected neurological symptoms.
The Neurology and Primary Care report presents the results of a survey of 1,001 regionally representative sample of GPs across the UK, and an expert workshop convened subsequently to discuss the polling findings. The expert panel included both patient representatives and clinical representatives from primary and secondary care, including a wide range of allied health professionals. The CSP was among the organisations represented in the discussion.
The survey findings clearly demonstrate low levels of confidence in the primary care pathway for people with neurological conditions. Most GPs in England (85 per cent) said they were either ‘somewhat concerned’ or ‘extremely concerned’ about the time taken for patients to see a consultant neurologist after being referred. This supports previous data from the Neurological Alliance’s survey of 7,000 people living with neurological conditions, which found that almost 40 per cent of respondents waited more than 12 months from when they first noticed their symptoms to seeing a neurological specialist.
The polling data suggests that GPs have concerns about both primary care services and the broader neurological pathway. Most GPs in England (84 per cent) felt they could benefit from further training on how to identify and manage people presenting with neurological conditions, while fewer than half (47 per cent) felt confident in their ability to make an initial assessment and referral for people presenting with the signs and symptoms of multiple sclerosis.
At the same time, most GPs expressed a lack of confidence in the availability of specialist services capable of providing a confirmed diagnosis for a neurological condition. More than half (59 per cent) of respondents said that the local services and systems in their area meant that people with neurological conditions did not receive a timely diagnosis on a frequent basis.
It is essential that NHS England and the Department of Health respond to these findings and engage with the concerns of GPs and people living with neurological conditions. Without an effective pathway through primary care, patients will continue to suffer from the consequences of undue delays to referral, diagnosis and treatment, and outcomes will also be affected.
Our report is available at It sets out eight recommendations aimed at improving the primary care pathway for people with neurological conditions, including a call for better guidance and support to help GPs manage these patients more effectively. Resources such as the guide to physiotherapy for primary care practitioners that the CSP recently published can support GPs to better understand the needs of neurological patients and the services that can support them See
We urge the government and NHS England to address these recommendations as a priority so that everyone with a suspected neurological condition receives a timely referral and diagnosis. 
Alex Massey, senior policy and campaigns adviser, Neurological Alliance

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