The traditional method of referrals from GP to outpatient neurologist based in acute trust (Medway Maritime Hospital) was no longer sustainable due to shortage of neurologist and increase demand. This caused an average waiting time of around 12 months for patients to see a neurologist and about 18 to 24 months before patient has a diagnosis. The Medway CCG as a part of neurology outpatient transformation had series of consultation with various stakeholers like primary care, secondary care and community organisation to come up with alternative plan to support the neurologist working for acute trust. . The new pathway set by Medway Community Healthcare (MCH) involves an extended scope neurophysiotherapist screening the e referrals (ERS) and seeing appropriate patients in the neurophysiotherapist lead Neurology Assessment Service (NAS) that involves assessment, investigation and treatment of appropriate patients which has managed to reduce the waiting time for these patients and freed up neurologist time to see more complex patient in a timely manner. The reason i want to share this activity is because this a novel pathway and hasn't been used before for wider neurology patients. This would encourage neurophysiotherapist to explore this area of extended scope practice as a career progression.


All the referral received from GP in Medway and Swale area received via ERS (Electronic referral system) were screened by experienced extended scope neurophysiotherapist to decideth e appropriateness of patient to be seen by Neurology Assessment Clinic (NAS) clinic, Orthopedic clnical assessment service (OCAS) within Medway Community Healthcare (MCH), neurologist or other consultants in acute trust (Medway Maritime Hospital), outside organisation like memory clinic or deemed inappropriate. Patients deemed appropriate to be seen in NAS clinic were assessment, investigated, managed and discharged by NAS where as some patients were referred onward to neurologist based on the investigation findings if the outcome of investigation was beyond the scope of practice of neurophysio. The data taken were: Number of patients referred through ERS deemed appropriate for NAS Number of patient referred through ERS deemed appropriate for consultant neurologist Number of patients referred through ERS deemed appropriate for OCAS or other services within Medway Community Healthcare Number of patient referred through ERS deemed appropriate for others Number of inappropriate referrals Waiting time of patients seen in NAS clinic Number of onward referrals to consultant neurologist after assessment in NAS Number of patient who were successfully discharged from NAS Number of patients who were referred for rehabilitation in community Patient satisfaction questionnaire


Results: The results were very encouraging as most patient who were referred to Neurology by GP through ERS were successfully assessed and managed by NAS clinic with only few onward referrals. The waiting times for these patients were reduced Appropriate patients could commence their rehab in community in a timely manner Encouraging outcome in Patients satisfaction questionnaire.

Conclusion(s): This new pathway helps in reducing waiting time for neurology patients, better patients satisfaction outcome and new opportunity for physio

Cost and savings

Medway CCG agreed to fund 2 wte neurophysiotherapist at band 7/8 following this pilot.


This opens a whole new area of career opportunity for neurophysiotherapists.

Top three learning points

No further information. 

Funding acknowledgements

Medway CCG for funding this pilot