No more neurophobia: welcome neurology in general practice

Abstract

Thirty years ago, there were 150 neurologists in the NHS. A higher neuroscience degree in a subspeciality of neurology was usual, in addition to clinical training for neurologists. There was no neurology training in service development for patients in the community, and little working in multidisciplinary teams. GPs remember adapting to work in the community was a challenge, even in a supportive training practice. New neurologists found a split contract job visiting one or more district hospitals, mitigated by returning to a university hospital 2 days per week. Many areas of neurology were adopted and organised by other specialities. Elderly care physicians took on stroke, epilepsy, and Parkinson's disease for older people, and psychiatrists took on epilepsy with learning disability and dementia. So the misperception arose that neurology was the study of rare conditions, by egg-heads. Now there are nearly 600 neurologists in the UK, and hospital beds have been radically cut, so apart from providing liaison advice in district hospitals, neurologists' main activity is doing outpatient clinics, like GPs. Primary care trusts (PCTs) are struggling to deliver Department of Health policies for vascular disease and cancer. How can neurology get itself on their radar screen? Enter Paul Morrish and his paper in this edition of the Journal.1 It raises important issues: the underdevelopment of neurology in the community for common conditions like headache, epilepsy, and Parkinson's disease; the skill mix, workforce planning, and training needed for diagnosis and long-term management; medically unexplained conditions; referral rates; and the politics of getting neurology noticed by PCTs. What should be the GP's role in diagnosing and managing neurological conditions? This should depend on the incidence and prevalence of each one. GPs will diagnose and manage the most common conditions, like headache and migraine. They refer for diagnosis less common ones, like …