Lack of services hits Parkinson's

A lack of specialist services for Parkinson's disease could leave GPs struggling to follow NICE guidance issued last week, experts have warned.

NICE cautioned GPs to refer all suspected cases of Parkinson's to specialists rather than initiating treatment themselves. It also said patients with Parkinson's should have follow-up assessments with specialists every six to 12 months (GP, 30 June).

Dr Carl Clarke, a Birmingham neurologist and clinical adviser on the guideline development group, said: 'The impetus has been on primary care doing more work and secondary care doing less. What we're saying is that's not an appropriate situation for Parkinson's disease.'

However, PCTs in some parts of England are preventing specialist follow-up consultations, meaning GPs are being left to perform such checks themselves, said Dr Clarke.

The NICE guidance also stressed the importance of access to Parkinson's nurses, as well as specialist physiotherapy, occupational therapy and speech therapy.

However, low availability of specialist services can leave GPs commissioning local therapists without expertise in Parkinson's, Dr Clarke warned.

Glasgow GP Dr Katherine Grosset, a GPSI in movement disorders, said the availability of specialist services might be limited because patients lived in remote areas or because local neurology departments lacked multidisciplinary teams.

'Resources and services are very variable,' she said.

'GPs are often the first point of contact when patients run into difficulties, which can be difficult as individual GPs might not have a great deal of experience in Parkinson's disease, and these are the very times when specialist advice is most needed.'

When it is assessed in the community, the rate of misdiagnosis in Parkinson's disease is about 50 per cent, compared with 6 to 8 per cent in hospitals.

But sometimes GPs are unable to persuade patients to attend hospital.

'Some patients just don't like hospital, and others are too frail,' Dr Grosset said.

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