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Not always A&E


7 February 2014

A&E are fed up with the number of unnecessary admissions  which could be dealt with in the community. People with epilepsy are tired of ending up in A&E when better epilepsy services would mean fewer seizures and fewer 999 calls. The solution seems simple. Epilepsy Society's publications editor Nicola Swanborough writes.

Walking out of Westminster into Parliament Square, my attention was grabbed by the signage on the side of a London double-decker bus.  'A&E won't kiss it better'  the advert read, ''

The message was loud, clear and direct. Unnecessary admissions to A&E are putting a huge financial strain on the NHS. A&E stands for 'accidents and emergencies', not  'anything and everything'. The NHS wants us to explore other services, where appropriate,  for our ailments - walk-in centres, GPs, community nurses, pharmacists - before limping to the end of what is often a four-hour emergency queue.

Funnily enough, that is exactly what we had been discussing in Westminster - how to keep people, or more specifically people with epilepsy, out of A&E.

It's a favourite of the epilepsy community. Ten per cent of emergency admissions and attendances at A&E are for convulsions and seizures. From 2012-2013, that cost the NHS a massive £1.25 billion. Furthermore, the National Audit of Seizure management in Hospital showed that 45 per cent of people attending A&E due to seizures, had attended A&E in the previous 12 months. A sure indication that seizure management in the community isn't always working.

Better epilepsy care in the community

The irony is that people with epilepsy are often carted off to hospital against their will when they have a seizure in the street and an ambulance is called.

But so many emergency admissions could be avoided if there was better epilepsy care in the community, better referrals to secondary and tertiary care for those  with uncontrolled seizures, a proportionate number of enhanced services including GP specialists and epilepsy specialist nurses which in turn could lead to better self management. Investment, yes, but savings too.

The meeting in Westminster, chaired by MP Laura Sandys who leads the all party parliamentary group on epilepsy, was called in response to  a government decision to scrap two out of the three indicators which are used to incentivise GPs to prioritise people with epilepsy. This means 90 per cent of the points that GPs could score for the provision of quality care for epilepsy have been removed.

The incentive  to identify patients who have been seizure free for 12 months has been deleted, as has the incentive to provide pre-conception counselling to the 139,000 women with epilepsy of child-bearing age. It doesn't mean that this won't happen anymore. It just means there won't be a box to measure performance against.

GPs and the NHS need to focus on areas where there is sub-optimal care and sub-optimal outcomes. We need to create a head of steam around epilepsy.  Epilepsy must be a commissioning priority.

Dr Chaand Nagpaul and Dr Richard Vautry say QOF is flawed

Dr Chaand Nagpaul, chair of the BMA's General Practitioners Committee and his deputy Dr Richard Vautrey, were adamant that the indicators - part of the Quality and Outcomes Framework -  were largely a box ticking exercise  and were not  focusing on the real needs of patients.

'Practices have become overwhelmed by box ticking,' Dr Vautrey told the meeting. 'We need to go back to first principles and encourage GPs and nurses to see people in a more holistic way. Epilepsy is a neglected area and we need to look at how the health service as a whole can be developed to provide  better care.'

Dr Nagpaul - who incidentally is one of only three GPs on the Sunday Times list of the 500 most influential Britons - echoed his feelings: 'GPs and the NHS need to focus on areas where there is sub-optimal care and sub-optimal outcomes. We need to create a head of steam around epilepsy.  Epilepsy must be a commissioning priority.'

Commissioning tool kit for epilepsy

We know. Epilepsy Society is already working with other epilepsy charities, NICE representatives, the Royal College of GPs and the national clinical director for neurological conditions. Together we are designing a commissioning tool kit for epilepsy that can be used by clinical commissioning groups nationwide.

Sapphire nurse consultant for epilepsy commissioning*, Juliet Ashton is exploring  local epilepsy services across health and social care with a view to improving pathways and outcomes for people with seizures.

There are 600,000 people living with epilepsy in the UK. Only 52 per cent are seizure free, when 70 per cent potentially could be.  As many as 20 per cent of people with epilepsy are misdiagnosed while up to 40 per cent of epilepsy-related deaths  could be avoidable.

Effectively, we are driving three London buses through NHS England, emblazoned with the word 'epilepsy.' The right people are talking. The right people are listening - some of the time. Now we want the right changes at community level that will give people with epilepsy optimum seizure control, minimum side effects from medication and maximum quality of life. Not always A&E.

*This role is the brainchild of Neurological Commissioning Support.