Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patientsare life threatening and require early specialistintervention.At the moment early access to neurological specialistadvice is not available in many DGHs in the UK. 2There needs to be an increase in neurology sessions inlarger DGHs to provide timely access to specialistopinion for patients admitted with neurologicaldisorders, with appropriate local access to relevantneurological investigations, eg neuroradiology andneurophysiology at the DGH.Patients with neurological disorders need to bemanaged on one ward of the hospital with suitablytrained nursing staff. Therapists and neurologicalrehabilitation can then be linked to this specialist team.Stroke servicesAcross the UK, neurologists have steadily but variablyincreased their involvement in acute stroke care,working in collaboration with care of elderly people,and stroke and acute internal medicine physicians, butthis needs to become more uniform, fully supportingand training junior staff.Neurology outpatient services (scheduled care)Patients with neurological problems should, wherefeasible, be seen for consultation as close to their homeas possible. Many patients with LTNCs can bemonitored by specialist nurses and/or GPwSIs, providedthat they are supported by the consultant neurologist.The principles of community care are as follows: local access for all patients with chronic neurologicaldisorders patient-centred care patients seen by an appropriately skilled clinician (egphysiotherapist, specialist nurse or consultantneurologist) identifying a key worker (nurse specialist,consultant, etc) designated consultant neurologist in charge better integration with social services improving clinical skills locally.Care pathways are required for patients with LTNCs andthe responsibilities of team members must be identified.Neurological care in the community is fully endorsed bythe RCP and ABN. 2Complementary servicesNeurologists support the use of complementarytherapies for their patients where there is an evidencebase.3 Working with patients: patient-centredcareWhat you do with patientsInvolving patients in decisions about theirtreatmentFollowing the initial outpatient consultation andinvestigation a diagnosis can usually be made andtreatment plans discussed with the patient, the familyand the GP. Some will require ongoing care, involvingrehabilitation and other local community services.Patients should have the name and contact details of akey worker and be able to access the most appropriatepart of the network at all times. For certain patientgroups, education, support and counselling are alsoundertaken by specialist nurses.In England, the national service framework (NSF) forlong-term conditions was launched in 2005, providing11 quality requirements to improve the care of patientswith LTNCs. In response, the ABN produced its owndocument setting out generic and specific guidance forimplementation with appropriate performancestandards. 3In 2011 the National Audit Office report 7 highlightedbasic problems with the NSF at its half-way stage.Services for people with long-term neurologicalconditions are not as good as they ought to be, despite alarge increase in spending. Progress in implementingthe Department’s strategy has been poor and localorganisations lack incentives to improve the quality ofservices.It is not clear how lessons will be learnt and there areriskstoserviceswhichtheDepartmentmustaddresstoensure that care improves.This was followed last year by a critical Public AccountsCommittee report 8 which concluded that:. . . services for people with neurological conditions aresimply not up to scratch, and the implementation of theFramework for improving neurology services has not174 C○ Royal College of Physicians 2013