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Getting It Right First Time in Neurology: a watershed moment in improving services?

The Getting It Right First Time (GIRFT) in Neurology report makes 26 clear and well-evidenced recommendations aimed at reducing the unwarranted variation in neurology practice and processes throughout England. 

The question now is how can we use this evidence to deliver the best possible care to people with neurological conditions? 

Recommendations in the GIRFT national report for neurology focus on: 

Access to care: the review found significant variation in the range of neurological services provided between sites and the way they are delivered, reflecting the way neurology services have evolved across the country. The GIRFT report recommends that neurology services should be available at all sites admitting patients with acute neurological disorders, either on site or through links with another site. 

Outpatient clinics: most neurology patients are seen in outpatients, with more than 1.3 million appointments a year. There is significant variation in outpatient activity and capacity across the country. Limitations in recording how and why outpatients are accessing services (coding) limits analysis and needs to be improved to better understand outpatient services, how people are using them and what is needed from them. 

Care pathways: the GIRFT review found variation in care for patients with seizures or suspected seizures, multiple sclerosis, Parkinson’s, migraine and other chronic neurological conditions. There was marked variation in access to specialist nurses between sites.  For some, regular treatments, such as disease modifying treatments for MS or botulinum toxin for dystonia, were available at their local hospital while in other areas these were only available at neuroscience centres necessitating significant travel.   

Workforce: the report also recommends the neurological workforce is developed to improve the distribution of neurologists and allied health professionals, which would result in better services for patients. The ambition is to establish services where the patients need them, and to train advanced practitioners to support this and to perform appropriate procedures in an outpatient setting. 

Experience varies too. The GIRFT report acknowledges variation in the availability of neurology input as a contributing factor to unwarranted variation. Our 2018/19 patient experience survey showed that experience of care varies markedly too, with significant gaps in access to timely diagnosis, support for mental health and a lack of co-ordinated care.  

Importantly, we found that people with a neurological condition living in more deprived areas of England were more likely to experience greater pain and discomfort and greater impacts of their condition on their daily life compared with those living in less deprived areas. 

So, what next? The report sets out 26 recommendations, including establishing a neurology data dashboard, improving access to specialist nursing and allied health professionals and developing sub-specialty specialist networks, starting with MS and epilepsy. We welcome these recommendations and will work closely with GIRFT and the wider neurological community to make them a reality.  

Right now, we need NHS England and NHS Improvement to set out a clear implementation plan so that we can collectively and collaboratively improve services.  

Fundamentally we need to ensure that people with neurological conditions play a key role in shaping service improvement. Whether that’s through leading work with clinicians to identify and understand patient experiences, co-chairing networks, lending their voices to workshops, taking part in one-to-one interviews, focus groups or surveys, they must be consulted, involved and at the heart of change. 

There are plenty of good examples of individual services co-producing solutions with people with neurological conditions, but we need this to be a central part of all service improvement. Here at the Alliance, we have a coalition of voluntary sector organisations willing and able to support collaboration and co-production at every stage.  

The publication of the GIRFT report, alongside initiatives to reform how neuroscience services are commissioned, the development of integrated care systems and forthcoming evidence from My Neuro Survey all provide huge opportunities to identify what needs to change and develop new ways to transform services. 

Let’s seize this watershed moment for change and bring about the improvements to services that are so desperately needed. 

Please contact us at info@neural.org.uk us to view the full report. 

Watch the presentations from the event below.

  • Dr Geraint Fuller, GIRFT Neurology Clinical Lead, watch here.
  • Dr Catherine Mummery, Consultant Neurologist and Chair of the Association of British Neurologist’ Services Committee, watch here.
  • Georgina Carr, Chief Executive of the Neurological Alliance, watch here.

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