Practice

Introduction

Currently, UK-wide there is a marked disparity between the resources available for Peripheral Neurophysiology and the numbers of patients referred. This has let to widespread lengthy waiting times for investigation. The Department of Health’s target in England of 18 weeks between GP referral and first definitive treatment has thrown this issue into sharp focus, and this document is part of the professions’ response to that situation. It is accepted that the status quo for Peripheral Neurophysiological investigations cannot remain, even had the DH not set this target, as longer investigation times lead to greater morbidity in terms of irreversable pathophysiology and patient distress. Quality of practice must be the prime aim, and that quality includes both the standard of investigation and the time that it takes for the whole process from referral to receipt of the report by the referrer. We must seek to achieve the optimum result for all factors taking into account the local service situation.

The likely future pattern of peripheral Clinical Neurophysiology services is a mix between Clinical Physiologist led clinics, Medical Clinical Neurophysiologist clinics and some clinics which use both types of professional staff. The degree of autonomy will depend on available staff, recorded competencies and local decisions.

In the past, attempts in the UK to create guidelines for common Neurophysiological procedures have foundered on strongly held but divergent views on who was qualified to do what, and what techniques were appropriate in any clinical situation. It was with these factors in mind that the Physiological Measurement Leadership group (PMLG) of the British Society of Clinical Neurophysiology/Electrophysiological Technicians Association have commissioned a new set of national guidelines to be prepared. Evidence based guidelines have been prepared in other countries, particularly in the USA but these again are culturally relevant and do not automatically translate across the Atlantic.

Terminology: As there remains doubt about job titles and to avoid confusion, practitioners are divided in two identifiable groups a) Consultant Clinical Neurophysiologists (CCN) and b) Clinical Physiologists (Neurophysiology) (CP).(also called currently or in the past Medical Technical Officers, Technicians).

This exercise is an opportunity to improve the quality and throughput of Peripheral Neurophysiological investigations. There will be inevitable differences of practice and professional opinion (but see the conscience clause). However, these guidelines should be considered a tool to underpin good standards of Clinical Neurophysiology and to be aspirational for improvements in both medical and physiologist practice.