Letters Thrombolysis in stroke

Stroke and neurological illness: the real lottery

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c457 (Published 26 January 2010) Cite this as: BMJ 2010;340:c457
  1. Paul K Morrish, consultant neurologist1
  1. 1Gloucester Hospitals NHS Foundation Trust
  1. paul.morrish{at}glos.nhs.uk

    Stroke is only one of the neurological illnesses that Choi might best have in London.1 London has four times as many neurologists per head of population than other parts of the country,2 and patients covered by a London primary care trust are up to six times more likely to be seen in outpatients by a consultant neurologist than those living elsewhere.3 This disparity comes after 10 years of neurology consultant expansion that has favoured specialist neurology centres rather than the district general hospitals around them. The introduction of the free market may have exacerbated this longstanding national lottery, with neurology provision reacting to demand rather than need. Manchester now has a wonderful stroke thrombolysis service, but many other parts of the country desperately need good thrombolysis and adequate inpatient and outpatient neurology opinion.


    Cite this as: BMJ 2010;340:c457


    • Competing interests: None declared.


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