The Guidelines are underpinned by discussions as to the possible future models of working of Clinical Neurophysiology departments as follows:

Version; post PMLG April 16th, 2006.

The Department of Health’s 18 week initiative offers a great opportunity for practitioners in Clinical Neurophysiology to improve their working practice as they seek ways to reduce waiting times. The aims of the PMLG Clinical Neurophysiology have been to conduct a census of waiting times and working practice in England and Wales, to suggest standards and guidelines for investigation and referral which it hopes will become accepted and adopted in England and Wales and to agree clinical competencies and educational requirements for circulation and agreement within the specialty. It is hoped that, once these proposals are accepted, the specialty will be more uniform and efficient.

One way waiting times may be reduced will involve extended working practice by Clinical Physiologists (CPs). This requires close and effective working relationships between Consultant Clinical Neurophysiologists (CCNs) and CPs. In relation to these the PMLG has identified four levels, or patterns, of working;

1. Department of Clinical Neurophysiology with CPs and full-time CCNs, allowing continual synergy between the two.
2. Department of Clinical Neurophysiology with CPs and attendance by a Consultant Clinical Neurophysiologist(s) for some days per week. This might be on a hub and spoke model working between neurological centre and DGHs.
3. Department of Clinical Neurophysiology without any attendance by Consultant Clinical Neurophysiologist(s) but with remote supervision using IT.
4. Department without any input by any CCN. Such a department might be of Clinical Neurophysiology with highly specialist CPs but might also involve members of a Department of Medical Physics or other health care science disciplines, with tests being performed by practitioners unrecognised by either the BSCN or EPTA.

Though wishing to explore the model above, the PMLG is concerned that the nature of the specialty, as part of clinical practice, should remain, with clinical assessment of patients, led by physicians trained and accredited in Clinical Neurophysiology or appropriately trained CPs remaining an important part of the process. The PMLG therefore recommends level I and II. It recognises level III practice, but cannot recommend level IV, especially without CPs.