Delivering Community Neurology In Liverpool – The Neuro Network

Showcasing the work of the NHS Vanguard at the Walton Centre NHS Foundation Trust

julie rileyJulie Riley is Programme Director for the Neuro Network. Prior to this she was the Divisional Director of Operations for the Division of Neurology Rehabilitation, long term conditions, Neuroradiology and Neurophysiology, and was also Acting Executive Director of Operations at The Walton Centre NHS Foundation Trust for a short period of time. She has worked in a number of senior leadership and operational roles across Merseyside, Cheshire and North Wales. She also holds the NHS Leadership Academy Award in Executive Health Leadership (Nye Bevan) and is a trained coach.

The Neuro Network is formed of different partner organisations from secondary and primary care, commissioners and the third sector, as well as patients and carers. Collectively, we are increasing support for people with neurological conditions. The Network, hosted by The Walton Centre – a specialist neuroscience Trust, was established with NHS funding under the New Care Models Programme. This challenged organisations to develop new partnerships to help improve health and care by thinking beyond traditional boundaries and by delivering effective change through greater collaborative working. The impact of this work has been significant with neurological patients seeing tangible benefits from the changes made.

A key pillar of the work is supporting primary care services. Many of the projects within the Programme are working to speed up the time it takes for patients to get access to specialist neurological advice and treatment. If patients get the help they need quicker, the management of their condition will be better, they will be less likely to go into crisis and need urgent care, admissions can be avoided but also length of stay, if they are admitted, will be shorter.

Evidence-based pathways have been drawn up that can help fast-track those patients who need specialist help more urgently than others, and help identify those that can be safely managed in primary care. The Headache Pathway developed by clinicians in Merseyside supports GPs in making referral choices and gives them clear guidance on the ‘Red Flags’  to look out for. This was developed as GPs were telling us it would be useful. Very often patients with persistent or recurring headaches can worry that the headache is a sign that they have something sinister. Many patients are unaware that brain tumours don’t usually cause headache but the GP needs support to reassure them and to be able to provide a clear management plan. Being able to share that specialist knowledge can also mean patients aren’t routinely sent for unnecessary investigations which can cause the patient more worry.

With the experience of Walton Centre Neurologists who specialise in Epilepsy, the Network is also embedding the use of a post-seizure pathway to support A&E departments and Medical Admission Units, asking them to refer in epilepsy patients to the Centre. The NASH (National Audit of Seizure Management) report highlights a wide variation in the care given to epilepsy patients in hospital and reinforces the need for a standardised approach.

In addition, we are sharing specialist neurological advice and guidance. We have expanded our advice lines to patients and GPs.  Focussed educational sessions, using GPs’ Protected Learning Time, has enabled the sharing of knowledge on a range of neurological conditions. These sessions, which are supporting Continuous Professional Development, have been well received by GPs.

Greater connectivity between tertiary, secondary and primary care is also provided by our Integrated Neurology Nurse Specialists (INNS). These nurses have been trained using a competency approach in a range of specialities and are in addition to specialist nurses based at The Walton Centre. The INNS work across Cheshire and Merseyside and run more than 27 clinics, enabling patients to access specialist neurological support close to home – something that patients have identified as being extremely important to them. The INNS act as a key worker for patients, liaising with hospitals and GPs, signposting them for clinical care, supporting practice nurses and community matrons. They also assist patients in other areas relating to their social care and their emotional, psychological support – again working to keep patients well outside hospital. In relation to wider health system challenges, they also have a key role in influencing attendances at AEDs by supporting patients who repeatedly attend in A&E to manage their condition.

The data coming through as a result of the projects clearly shows the benefit of working in this way:

  • There has been a 20% reduction in headache referrals to The Walton Centre between October 2016 and September 2017.
  • Nearly 3,000 patients received advice and guidance on our telephone Nurse Advice Line between July 2016 and June 2017, supporting them in empowerment and self-care management and potentially avoiding a primary/secondary care appointment.
  • Between January 2017 and December 2017, the INNS team has supported more than 1,500 patients with neurological conditions closer to home in community or home visits – a 50% increase from 2016-17.

The work of the Neuro Network continues to inform the wider health economy as a cross-cutting theme within the Cheshire and Merseyside Health Care Partnership which emerged from the region’s former Sustainable Transformation Partnership. There is great potential for enhancing and standardising the care of patients with neurological conditions. This is done by taking a whole system approach to see how the work of the Network can not only influence neurological care but care of all patients within the system.