Health CommitteeWritten evidence from the Association of British Neurologists (ETWP 52)

1. Specialty Training in Neurology

1.1 Specialty training in neurology is a five year programme, entered by trainees who have completed their foundation training (two years) and core medical training (two years) and is undertaken within a curriculum approved by the GMC in 2010.1 The training, which is overseen by the Specialty Advisory Committee in Neurology, provides what is recognized internationally as a high quality clinical training in neurology.

1.2 Neurology in the UK is much smaller than in the rest of the world—in the UK there is on average one neurologist per 150,000 population as compared to 1 per 25,000 in the rest of Europe.2 There has been a modest increase in the number of neurologists in the UK to bridge this gap and improve the access of patients with neurological problems to specialist opinion. However, because of the shortage of neurological trainees in the UK, many of these posts were filled by neurologists from abroad, mainly other EU countries.

1.3 The recent review by the Centre for Workforce Intelligence (CfWFI) concludes that the numbers of trainees are appropriate at the moment.3 Unfortunately their calculations included the “Hewitt-Johnson” posts, whose funding is running out over the next year. As a result the number of trainees will fall by about 10 per year resulting in a significant underproduction of trained neurologists in the next few years.

1.4 We anticipate that more patients and their GPs will want to access specialist neurology services, and that patients with acute neurological disease will require greater involvement of neurologists in their care explored in detail in Local Adult Neurology Services for the Next Decade.4 This will depend on an increase in training numbers beyond those anticipated by the CfWFI in its review.

1.5 We are concerned that the central mechanisms controlling training numbers has tended to take a conservative view on potential changes of this sort likely to be brought about by the new commissioning mechanism. In the past they have not been flexible enough to respond to this type of anticipated change. As a result, the significant increase in number of neurologists over the last 10 years was not been met by consultants trained within the UK.

1.6 The training programmes are currently organized across regions to allow the trainees appropriate experience in the wide range of neurological subspecialties and to allow them to be involved in the care of patients with a wide range of neurological disease. With provision of clinical services potentially moving out of the current hospital settings to more diverse providers it is plausible that certain areas of clinical neurology will no longer be accessible to trainees—for example headache or epilepsy clinics. This would fragment training and potentially make it harder to achieve full curriculum coverage.

2. Training in Neurology for those Other than for Specialty Trainees

2.1 General Practitioners with a Special Interest (GPwSIs)

Some proposals have suggested that the shortage of trained neurologists may be mitigated by using General Practitioners with a Special Interest (GPwSIs) to provide some neurology out-patients. This is widely used in some other specialties, for example dermatology. However, very few GPs will have had any formal neurological training beyond the one to four weeks as medical students and as yet there is no curriculum or assessment mechanism in place for the training of GPwSIs. If the GPwSI works alongside a consultant neurologist providing clinical support and includes the GPwSI within the clinical governance structure of the neurological team, quality can be assured.

It seems likely that in some areas GPwSI may compete for the provision of services to some patients with neurological diseases outside a neurological team. Given the lack of a formal training and assessment framework the quality and nature of such a service would be uncertain.

2.2 Specialist nurses

Specialist nurses are increasingly important in providing quality care for patients with chronic neurological illnesses, particularly for epilepsy, multiple sclerosis, motor neurone disease and Parkinson’s disease. The distribution of specialist nurses around the country is highly variable and we are not aware that there is any central planning from the Department of Health. The relevant disease specific charities have been very active in promoting specialist nurses as they regard them to be of high value for patients.5 While there are certain qualifications that specialist nurses can achieve, for example an MSc, there is no specialist registration process.

Specialist nurses work most effectively alongside the consultant with expertise in their disease area to allow appropriate support and clinical governance. There is a risk that this may be fragmented by the wider range of providers within the NHS.

December 2011

1 Specialty Training Curriculum for Neurology
http://www.gmc-uk.org/Neurology_Curriculum_FINAL_301110_V0.19.pdf_40512716.pdf

2 Acute Neurological Emergencies in Adults
http://www.theabn.org/abn/userfiles/file/AcuteNeurologicalEmergenciesinAdults.pdf

3 Recommendations for neurology training
http://www.cfwi.org.uk/intelligence/cfwi-medical-factsheets/recommendation-for-neurology-training-2011

4 http://bookshop.rcplondon.ac.uk/contents/pub354-2b209ee8-f1f9-4259-9075-bdfa1accdb3e.pdf

5 Best care: the value of epilepsy specialist nurses
http://www.esna-online.org.uk/documents/FV%20Best%20care%20Jul2010.pdf

Prepared 22nd May 2012