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Quality pay fear over epilepsy 'avalanche'

GPs will struggle to achieve quality points for epilepsy under the new GMS contract as huge numbers of missing patients come to light, specialists have warned.

Studies presented to the recent Epilepsy Policy Changes conference in London showed care of epilepsy is 'fragmented and poorly recorded' with only 45 per cent of patients ever having seen a specialist.

Under the new contract GPs can earn up to 16 quality points for epilepsy care, including setting up a register of patients receiving drug treatment. And recent guidance from the Scottish Intercollegiate Guidelines Network recommends that a diagnosis of epilepsy and the initiation of anti-epileptic drugs should only be made by a neurologist or other epilepsy specialist.

But an audit of 12 practices in Buckinghamshire presented to the conference by National Society for Epilepsy lead nurse Annette Russell revealed only half the 608 patients with epilepsy had the frequency of their seizures recorded and that fewer than a third had seen a specialist.

Dr David Smith, consultant neurologist at Liverpool's Mersey Regional Epilepsy Clinic, said: 'When GPs start to create disease registers they will find hundreds of thousands of people with epilepsy have never seen a specialist.'

He said secondary care did not have the capacity to cope with an 'unselected avalanche' of patients but that GPs would find it difficult to prioritise referrals. Dr Smith added: 'I have heard people say you can get the 16 quality points if you get the practice nurse to see the patient, but that would be a disaster.

'GPs have to see patients themselves and it won't be easy for them. They will find that diagnosis can be unclear, patients might be having unrecognised attacks and so on.'

Ms Russell said quality pay should prove a useful starting point for improving management of the condition.

Fellow National Society for Epilepsy nurse Anita March said it was vital that GPs provided specialists with appropriate information about referrals.

By Cato Pedder

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