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

2 Specialties Neurologyworked . . . we identified an absence of leadership atboth national and local level and poor integration ofservices as key weaknesses that must be addressed. It istherefore extremely disappointing that the Departmenthas rejected our recommendations in relation to theseissues . . . the Department has got to do better and wewill be taking this up with them in due course.Neurologists are often part of the team providing carefor patients who are at the end of their lives. Patients,carers and families need to be kept fully informed aboutprognosis and the range of services available. It isessential to coordinate pain control and emotional andpsychological care.Patient support groupsPatients and carers should have access to high-qualityinformation about their neurological condition,investigations and treatment, and to local branches ofneurological charities, together with a wide range ofhealthcare workers. Increasingly, neurological patientsare experts in their condition and may be part of themultidisciplinary team (MDT) as expert patients.Availability of clinical records and resultsAll patients should be offered copies of clinic letters andthe results of investigations. Patient records should beavailable at all times to all treating agencies. This is nowincreasingly possible by electronic means.4 Interspecialty and interdisciplinary liaisonMultidisciplinary team workingNeurologists frequently work as part of MDTs whencaring for acutely ill patients and especially for patientswith LTNCs. Clinical nurse specialists and therapistswith knowledge of neurological conditions are key teammembers and some should be based in the community.Links with care of elderly people and social servicesneed to be better developed, so that patients receive theappropriate care and support required.Transition careThe ABN fully supports the RCP’s young adult andadolescent initiative to improve healthcare outcomes forthose aged 16–24 years. Some neurologists alreadyundertake transition clinics with paediatric colleagues(in specialties such as epilepsy and neuromusculardiseases) but there is a need to increase the profile ofthis type of specialist service and to ensure that it isappropriately supported by trusts and health boardsacross the UK.Working with other specialistsManaging acute neurological conditions involvesworking with acute and other medical specialists in themedical admissions unit (MAU) and during wardliaison to improve appropriateness of investigations,obtain early diagnosis and speed up discharge fromhospital by facilitating appropriate follow-up. There hasto be a close liaison with radiologists, intensivists andneurophysiologists, and the involvement ofneurosurgery and neurorehabilitation. Neurologistshave an increasing role in stroke care together withstroke physicians and geriatricians. Neurologists alsowork with psychiatrists in dementia services.Long-term condition services need neurologists,neurorehabilitationists, geriatricians and palliative carephysicians.Close liaison also exists between neurology and otherspecialties in the following areas: Parkinson’s disease(geriatrics), dementia (psychogeriatrics), higherfunction disorders (neuropsychiatry andneuropsychology), double vision and visual loss(ophthalmology), dizziness (ear, nose and throat,audiovestibular physicians), peripheral nerve and nerveroot disease (orthopaedics), inherited neurologicaldisease (clinical genetics), functional disorders(psychiatrists), pain teams and obstetric services.Working with GPs and GPwSIsCare for patients with LTNCs has traditionally beenbased in DGH or RNC outpatient clinics that are mainlyconsultant delivered, and more recently have had nursespecialist input. Newer networks of care are developingwith the involvement of primary care, and neurologistsare key members of these networks. Better use needs tobe made of combined meetings, educational seminarsand clinical guidelines to underpin this network.5 Delivering a high-quality serviceWhat is a high-quality service?The ABN and the Neurological Alliance(www.neural.org.uk) are currently assessing whatoutcomes can be measured to reflect high-quality care.These have to be meaningful and applicable to allneurology units in England, Wales and NorthernIreland. Scotland has published clinical standards forC○ Royal College of Physicians 2013 175