By Matt Jarram, Local Democracy Reporter
Health bosses have said there are not enough neurologists at Nottingham’s hospitals after it was revealed some patients are waiting more than 18 weeks for an appointment.
Nottingham University Hospitals NHS Trust (NUH) says this can lead to a delay in diagnosis for Parkinson’s or Motor Neurone Disease.
Some patients are also waiting a year to be seen again by NUH once they have been diagnosed with a serious condition of the nervous system.
Staffing shortages mean there are currently only 15 consultants in the department.
In the last six months, the trust has managed to recruit two new consultants, but they are yet to be in post.
Councillors questioned Dr Jonathan Evans, head of service for neurology at NUH, and medical director, Keith Girling, at a health and adult social care scrutiny meeting on July 14.
Neurology deals with disorders of the nervous system including the brain, spinal cord and muscles and includes epilepsy, dementia, multiple sclerosis, strokes, Parkinson’s disease, and muscular dystrophy.
The service is mainly based at the Queen’s Medical Centre with some clinics at the City Hospital.
Cllr Georgia Power (Lab), chair of the committee, called on health bosses to attend the meeting after being contacted by a number of concerned residents and GPs.
She said they are becoming “increasingly concerned” that GP referrals were being turned down by the department and patients were unable to access the service.
In papers prepared for the meeting, Mr Evans said the service serves not only the people of Nottingham and Nottinghamshire but Leicester, Derbyshire, and Lincolnshire.
He said: “At NUH, we have large cohorts of patients with conditions including Parkinson’s disease, multiple sclerosis, epilepsy, myasthenia gravis and Motor Neurone Disease, as well as smaller numbers of patients with chronic nerve or muscular disorders which need regular monitoring.
“The demands that the care of patients with long term disorders places upon a neurology department are formidable.
“Our service had challenges even before the pandemic with patients frequently waiting more than 18 weeks to receive an outpatient appointment, which often meant a delay in diagnosis for some diseases, such as Parkinson’s or motor neurone disease.
“With our current capacity we are able to see patients with Parkinson’s disease at a minimum of seven-month intervals, and for epilepsy and multiple sclerosis the figure is closer to 12 months. This is not the service we want to be able to provide for our patients.”
He said the department receives more than 150 weekly referrals but can only offer in the region of 60 to 70 appointments per week.
He said: “As you can see the capacity doesn’t quite meet the needs hence the historical (over 18 week) waiting times for a neurology outpatient appointment.”
Cllr Power asked Mr Evans: “You say there are 30 consultants in Sheffield, and we have 15 to 17 – do you think we have enough?”
Dr Evans responded: “No. We are creating a business case to support more neurologists. We have two new consultants, but they have not started yet. When they do start the role, their clinics will be booked with patients so there is an element of supply meets demand.
“We are looking at ways of expanding the consultant base, but it is a difficult climate to get funding for new positions.”
Cllr Michael Edwards (Lab) said: “It feels like you need a step change not a business case.”
Dr Keith Girling explained how referrals from GPs to the department are now vetted and then triaged by a team.
The consultant will then triage the referral to either a general neurology clinic – video or face-to-face depending upon the nature of the presentation – or a specialist clinic, or take simple management steps that can be undertaken first in primary care.
He said this was not about doing less work but prioritising time for patients with a higher probability of an underlying neurological disease.
There is also a target to have waits of no longer than 10 weeks.
Dr Evans told the committee: “It is not about workload or creating barriers, it is about seeing the right patient at the right clinic at the right time. “
