Inadequate neurology services undermine patient care in the UK

“Neurology for the masses” announced The BMJ’s then editor, Richard Smith, in 1999.1 Old stereotypes may associate neurology with rare syndromes and a fondness for diagnosis not treatment, he went on, but it is also a specialty of common illnesses such as epilepsy and Parkinson’s disease. He might also have mentioned that neurological symptoms include some of the commonest complaints such as headache and fatigue. Sixteen years on and despite a doubling of consultants, a damning parliamentary report,2 thrombolysis for stroke, and an awareness of increasing neurodegenerative disease only people living in select areas, or able to travel, will encounter a neurologist. The Neurological Alliance, a patients’ organisation in England, reports that 31% of patients had to see their primary care doctor five or more times, and 40% waited more than 12 months with symptoms before seeing one.3 The UK is the only developed nation with this problem. We have one neurologist per 90 000 people4; the European average is one per 15 000,5 and in the United States concern has been expressed that one per 19 000 isn’t enough.6