Transforming neurology services: a practical way forward

On 27th May, 60 healthcare professionals spanning commissioning, management, clinical work and the voluntary sector gathered to hone their understanding of neurology commissioning. Find our conference overview here or read on for a better understanding of commissioning in neurology!

Clinical Director and CCIO of the Walton Centre, Dr Martin Wilson, highlighted the transformation agenda that is being taken forward following on from the GIRFT neurology specialty reportand delegates were delighted to hear a great deal of - as yet - unpublished information.

NHS England and NHS Improvement (NHSE/I) have set out their plans to delegate responsibility for a range of services to an Integrated Care System (ICS) level. This means that many services that are currently planned and commissioned at a national level (i.e. specialised) will now be planned and commissioned at a regional level. The Roadmap for integrating specialised services within Integrated Care Systems is part of the broader NHSE/I reform that will fundamentally change how many services for people affected by neurological conditions are commissioned (table 2).

Table 2: Service information as set out in the Roadmap for integrating specialised services within Integrated Care Systems

Martin shared that multi-disciplinary approaches at differing levels would be key to transforming neurology services, outlining MDT clinics, MDT meetings and regional MDT meetings, all of which have different functions. The Regional MDT meeting is new to the neurology space and will be used at tier 3 to address specific complex cases, unblocking systemic service inaccess or implementing wider policy implementation. Examples of a regional MDT meeting requirement include:

• Implementing policies for any NHS England drug / surgical intervention e.g. DMT use

• Access to neurogenetics or genomics services to support personalised care for refractory cases

• Access to unlicensed treatment where other interventions have failed

• Access to complex surgical interventional e.g. neurosurgery for epilepsy

Martin was clear that Regional MDTs will require specific organisation at regional level to provide governance for service provision and that vehicles to ensure this include appointing the first national clinical director for neurology, new governance models, a new neurology service specification, defined outcome measures and key performance indicators (KPIs) and partnership working across various organisations within and external to the NHS.