12 September 2019


Getting It Right First Time publish neurology methodology

Getting It Right First Time (GIRFT), a national programme aiming to improve NHS care by reducing unwarranted variations in service, has published its regional findings about how services are delivered to people with neurological conditions, along with the methodology behind their analysis. The report shows wide regional variation in terms of access to neurologists, spend and outcomes such as emergency admissions.


To account for the different ways in which neurology services are provided across the country, data is compared between ‘neuroscience regions’ made up of NHS trusts with links to a shared neuroscience centre. GIRFT has also sought to define the regional ‘patient population’ for each ‘neuroscience region’. They have done this by looking at which hospital people with neurological conditions would typically go to if they were to attend A&E. This is referred to as the ‘non-elective population’. Key variations between neuroscience regions include:


  • The number of neurology consultants ranges from 1 per 43,000 to 1 per 200,000 of non-elective population, with an average of 1 per 79,000
  • The number of specialist registrars (doctors training to become consultant neurologists) also varies between 1 per 48,000 and 1 per 500,000, with an average of 1 per 167,000 of non-elective population
  • Emergency neurology admissions varies from 5 to 250 per 100,000 of non-elective population
  • For most regions, the spend on emergency neurology services ranges from £0.90 per head to £5.10 per head.


GIRFT base their patient data on those admitted and discharged with a diagnosis of a primary neurological disorder. In terms of patient experience, variations are measured using further subdivision based on perceived likelihood of a better outcome from direct neurological care:


  • The proportion of those with neurological diagnoses categorised as ‘definitely’ receiving a better outcome from direct neurological care (e.g. encephalitis, epilepsy, MS, Guillain-Barre or myasthenia gravis), varied as much as 4.8% in the lowest region to 47% in the highest
  • For ‘probably’ (e.g. meningitis, headache, Parkinson’s), the variation was 1.1% to 30%.


Other key findings include:


  • Regional inequalities resulting from the correlation between proximity of a patient’s CCG to their specialist neuroscience centre and funding received from Specialised Commissioning
  • Specialised Commissioning funding varies by CCG from £55 to £18,000 per 1,000 of the population per year, with London CCGs averaging £7,787 while the Midlands and East of England averaged £2,429.


Overall, the findings show significant variation in neurology services across England. This has significant implications for the level of service people with neurological conditions are likely to receive.


The neurology GIRFT is doing some very important work, and its initial findings prove that there remains too much of a post code lottery for people with neurological conditions. People deserve the best care, regardless of where they live, but the initial data suggests significant room for improvement. A national plan for neurology is needed to establish a strategy to address this.

Sarah Vibert, Chief Executive, The Neurological Alliance


GIRFT and NHS England aim to identify and use best practice in service provision and funding respectively, to begin to address the variation identified. A full GIRFT National Neurology Report is expected to be published in the autumn of 2020.