How general practice can help improve care of people with neurological conditions: a qualitative study

The aim of this qualitative study was to examine the experiences and needs of patients and carers affected by one of three common neurological conditions and to explore how primary care can contribute to improvements in care. Data was drawn from five focus groups recruited from various geographical locations in the north of England served by seven primary care trusts and four neurological departments. Researchers in a semi-rural practice recruited 38 participants, 15 of whom were male and 23 were female. Ages ranged from 26 to 74 years. The participants were either patients or carers of people with epilepsy, multiple sclerosis or Parkinson’s disease and were recruited from three settings: primary care (two groups), voluntary groups (two groups) and secondary care (one group). The results showed that neurological care could be patchy, overstretched and insensitive to the individual patients’ needs. Communication between patient and health professional, and between different sectors of the health service is poor and often leads to time wasting and delays in treatment. The impact of these conditions on the patient and their family and their preferences for treatment varies. Specialist nurses are highly valued by patients and their families but the service is overstretched and access is difficult. General practitioners (GPs) are valued for their communication skills and their ability to act as advocate for the patient; however, there are doubts about their knowledge of neurological conditions. Problems of service access were identified. The skills of health professionals in general practice can be used to complement those in secondary care. GPs and nurses are considered a valuable resource that could be used better to improve neurological care, particularly in fostering patient participation in decisions about their care. Practice-based commissioning offers an opportunity to review services to make better use of the time and skills of all professionals involved in the provision of care.