Draft NICE neurological advice could benefit 34m GP consultations

NICE has launched draft guidance to support GPs in treating patient with neurological conditions, which account for one in 10 appointments in primary care.

GP consultation (Photo: JH Lancy)
GP consultation (Photo: JH Lancy)

Draft guidance on suspected neurological conditions, currently out for consultation, is designed to ‘help non-specialist healthcare professionals to identify people who should be offered referral for specialist investigation’, NICE said.

Neurological conditions, including MS, epilepsy, migraine, Parkinson’s and dementia, account for about one in 10 GP consultations, totalling over 34m per year.

Nearly a third of patients with a neurological condition had to see their primary care physician ‘five or more times’ before being referred to a specialist, NICE said.

These referral issues ‘stem from a lack of support and knowledge’ in primary care, it warned, which has ‘led to delays’ in referral for people with treatable or potentially serious neurological conditions and unnecessary referral for others.

But it added it was ‘impractical for a generalist to keep abreast of the range of neurological treatments available and sometimes to appreciate the significance of neurological symptoms’.

Neurological conditions

The guideline contains recommendations for 14 symptoms in adults that could indicate neurological problems, alongside 15 recommendations for children under 16.

Among the proposals, it advises GPs to refer urgently adults with new-onset blackouts, facial pain with persistent numbness, sudden speech problems and rapidly progressive unsteady gait.

A consultation on the guideline will run until 19 September, with the final guideline to be published next year in January.

The guidance says: ‘Neurological symptoms in primary care may be difficult to interpret, which can make diagnosing neurological conditions difficult and the decision about whether to refer for a specialist opinion or for investigation challenging.

‘Interpretation of the examination of the nervous system to determine the significance of physical signs and distinguish functional from organic symptoms sometimes requires a high level of skill, and referral for a neurology assessment may be appropriate to undertake this.

‘People with suspected neurological conditions often need referral to a specialist to be diagnosed and treated. However, some referrals are unnecessary as the neurological condition can be managed adequately in primary care.’

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