Outpatient services (scheduled care)
Patients with neurological problems should, where feasible, be seen for consultation as close to their home as possible. Many patients with long-term neurological conditions (LTNCs) can be monitored by specialist nurses and or GPwSIs and hospital practitioners, provided that they are supported by the local consultant neurologists.
For many conditions the outpatient follow-up is organised into specialty clinics, most commonly for people with epilepsy, Parkinson’s disease, botulinum toxin for movement disorders, and motor neurone disease. These specialist clinics will usually be at neurology centres and regional neuroscience centres. Specialist clinics for people with rarer conditions, for example neurogenetic disorders or following movement disorder surgery, are based at the regional neuroscience centres. Certain specialist services, such as disease modifying therapies for people with multiple sclerosis, are provided by services based in the regional centre, the neurology centre and sometimes a DGH, which are then networked via a cross regional MDT and clinical governance structure. Multiprofessional clinics are also provided in certain specialist areas, such as motor neurone disease, where neurologists work alongside palliative medicine consultants.
The aim is to provide the most appropriate specialist service as close to the patient’s home as possible.
The principles of community care are:
- local access for all patients with chronic neurological disorders
- person-centred care
- patients seen by an appropriately skilled clinician (eg physiotherapist, specialist nurse, or consultant neurologist)
- a key worker identified (nurse specialist, consultant etc)
- a designated consultant neurologist in charge
- better integration with social services
- improving clinical skills locally.
Care pathways are required for patients with LTNC and the responsibilities of team members must be identified. Neurologists’ care in the community is fully endorsed by this working party report (opens PDF, 468KB) from the Royal College of Physicians (RCP) and the Association of British Neurologists.
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