Delivering an advice and guidance service in neurology

Abstract

It is increasingly common for secondary care to provide advice to primary care without an outpatient appointment. Even before the increased telemedicine during COVID-19, many hospital services gave advice alone for some referrals, yet there are few published data about patient outcomes. Does advice and guidance alter outpatient numbers or simply mean that patients are seen later? Which neurological conditions can we manage at a distance? Do complaints increase from either primary care or patients? Do clinics become more complex and time consuming? Our department has developed an advice and guidance service embedded within the English electronic referral system since 2017, allowing detailed analysis of the outcome of 6500 patients over 2.5 years. We suggest ways to set up and run a neurology advice and guidance service, looking at the potential benefits and the barriers.

Keywords: clinical neurology.

Figure 1

The GP view within the electronic referral system (e–RS) of our inclusion and exclusion list. GP, general practitioner.

Figure 2

(A) Requests received during June 2018. A total of 214 sequential advice and guidance requests received with the symptoms described. (B) The total number of advice and guidance requests (darker lower line) and new patient attendances within Newcastle service (upper line) from April 2018 to December 2020. Number of patients are shown per month.