Implementing a Direct referral pathway for Patients with Parkinson’s disease

By Jo Fuller, Advanced Neurology Nurse Practitioner


“Parkinson’s is a complex, chronic, incurable, fluctuating and disabling condition. It is a degenerative neurological condition affecting all aspects of daily living and has a major impact on quality of life. However, its effects can be mitigated by timely interventions (medication and early mobilisation).

Parkinson’s has a prevalence of 100-150 per 100,000. 1 in 3 people with Parkinson’s are admitted to hospital each year. Parkinson’s patients have higher rates of emergency admission with longer hospital stays, associated with higher costs and in-hospital deaths. The main contributing factor is poor medication management, a situation which NHS England has described as “unacceptable”.

The James Paget University Hospital is situated in Gorleston, it covers the Great Yarmouth and Waveney area and crosses the Norfolk and Suffolk border. The hospital provides services to a population of 280,000. There are 800 patients with Parkinson’s disease under the care of two Consultant Neurologists and one part time Neurology Nurse Practitioner in the acute sector, with four whole time Neurology Nurse equivalents in the Community sector. There is no designated ward for Neurology patients or Parkinson’s Specialised Neurologist at the hospital.

People with Parkinson’s disease (PWP) are more likely to have an unplanned admission to hospital via A&E or EADU than the general population with associated poorer outcomes. When PWP are admitted they can face complications with their care such as delayed or omitted medications potentially leading to issues with mobility or non-motor symptoms that are usually controlled under their normal medication regime.

When the patients are admitted to a ward they can be spread all over the hospital. This presents a logistical problem for the specialist team and patients are often not seen by a Neurology Specialist.

The purpose of this project to streamline care services by implementing a direct referral pathway for patients that are admitted to the James Paget Hospital with Parkinson’s disease.

My hypothesis is that by enhancing the patient’s journey from Emergency care to the Ward setting with staff that have a greater understanding of Parkinson’s disease and the knowledge of appropriate medicine management, this will improve not only the quality of the patients admission but may reduce length of stay. With the added bonus of a designated ward area that has the ethos of effective communication between multi-disciplines and a one stop shop for the Neurology Team.

This is outlined in my proposal outline attached which was submitted in September. The pathway is yet to be implemented.

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Parkinson's Academy, our original and longest running Academy, houses 20 years of inspirational projects, resources, and evidence for improving outcomes for people with Parkinson's. Led by co-founder and educational director Dr Peter Fletcher, the Academy has a truly collegiate feel and prides itself on delivering 'the things you can't get from books' - a practical learning model which inspires all Neurology Academy courses.