Gwam Rajiah looks at the issues confronting neurophysiology departments around the UK

Neurophysiology – the conduction of nerves in the human body – is an essential but often overlooked sector of the healthcare industry.  As such, waiting times, patient service and overall pricing are usually outside the parameters set by the Department of Health.

Having worked in the NHS for over 33 years, which culminated in a senior role at Royal Preston Hospital where I was responsible for renal, plastics and neurosciences, these issues confronted me and my colleagues around the country on a daily basis.

Now I sit looking from the outside in, where I continue to talk to hospitals around the country, it has given me a clear insight into public versus private delivery of this vital area.

In non-essential cases, the patient process from initial referral to a consultant clinical neurophysiologist to the delivery of the results can be a long and winding road.

In my experience, the majority of neurophysiology departments aim to work within the 18 week target with the overall plan to cut the length of the process to nine weeks through extra clinics and the purchase of new equipment.

The reason for the delays and the need for extra expenditure is not due to mismanagement, but many departments do not have the resources due to logistical, financial and sometimes personal reasons, to cope with the tests by the referring doctors and direct GP referrals.

Having seen over 4,000 patients in 2009 on behalf of some of the country’s leading healthcare establishments, I have proof of two year waiting times for the EMG test alone.

The neurophysiology waiting game

Average waiting times for patients

  • Initial appointment with a consultant: 6 weeks
  • Wait for nerve conduction studies test: 4 weeks
  • Second appointment with a consultant: 6 weeks
  • Total: 16 weeks

Due to the elongated nature of the process, the true cost of a neurophysiology test starts to become a major issue. The price of the consultant clinical neurophysiologist, the test, the clinical physiologist, the equipment and the room can add-up to a sizeable figure.

This complex sector of the healthcare industry is still awaiting NHS tariffs to show true cost, and I will use this platform to again call for these to be introduced sooner rather than later. It is only at this point that healthcare institutions will fully realise the scale of the problem and reduce costs.

Heads of departments all around the country know that something must be done, but many find their hands tied when they wish to streamline the process. Add to this that some are unaware that there are alternatives options in the marketplace, and as such the problem is never addressed.

Many hospitals are reticent to use private firms for complex procedures as they expect exorbitant costs and question the quality of the service. This is largely a misconception.

Over the past year, we have undertaken work for Nottingham University Hospitals Trust, Wrightington Wigan & Leigh foundation trust and Oxford Radcliffe Hospitals trust, to name but a few.

This is only a very quick overview of a complex sector, but one I sincerely hope will start debate on the delivery of neurophysiology in the UK.  There are numerous problems to be overcome in hospitals, and when they are I will happily close my business and move on.

During the interim period, this item must be raised up the agenda quickly, and over the coming years I will be lobbying the Department of Health to raise all these issues in far greater depth. Should people wish to join me on this endeavour, I will welcome their support and knowledge. 

I also urge hospitals to look at alternatives in complex areas and to undertake their company research properly to ensure the quality of service and competitive pricing. Not only can the right business help reduce waiting times, they can ultimately become a leading example of service delivery.