View from the floor: neuroscience services

The success of the neuroscience integrated clinical assessment and treatment service is based on its effectiveness in overcoming many bottlenecks in the neurology referral pathway that had made it impossible to meet the 18-week target. The triage system it uses means patients are seen by the right kind of doctor in good time. In some cases they can even be scanned and diagnosed without a doctor's appointment, which offers considerable cost savings.

The service resulted from open and fair collaboration between Salford Royal foundation trust, Salford primary care trust and Manchester University's MRI scanner and resolves some difficult issues of access. At first sight it seems to run against the intentions of the Department of Health, which gave GPs open access to MRI scans, even though they did not have the training to interpret the results they were getting back. Things needed to change and in supporting us to set up the service, the PCT acknowledged this, even if it meant running seemingly contradictory policies.

For the service to work, we had to be sure of getting all the referrals from a particular catchment area. The solution subverts choose and book by giving GPs access to neurology through us. Having selected the clinical service required, we then offer choice.

This arrangement depended on the co-operation of the PCT management, and funding from their diagnostics lead.

Once the PCT and managers in acute care had accepted the risk of setting up this service, they stood back and trusted us to sort it out. This reduction in management control is unique in my experience. It also has benefits for local managers, who are busy enough without additional projects.

We might have ended up with what can seem like a massively complex structure - but we can make it work efficiently and to everyone's advantage. The only alternative would have been employing many more doctors.

People are keen to roll the model out across Greater Manchester. However, with so many PCTs in the area, there are hurdles to get over. Unpicking some of the financial arrangements between primary and secondary care organisations is just one.