Services for epilepsy in the United Kingdom

The United Kingdom's (UK) National Health Service is a universal service that delivers health care that is largely free at the point of contact, the costs offset by general taxation and an employment tax. One great strength of the system is its delivery of primary care. Each patient has an assigned general practitioner who is responsible for the overall management of his or her ongoing health care, including the prescribing of medications and assigning of appropriate referrals for any specialist services. Recently introduced changes in national budgeting are likely to cause general practitioners to play a more direct role in the purchase of patient services from providers of secondary or specialist care.

Physician demographics. It is estimated there are 155,000 doctors in the UK, of whom 23% are primary care physicians. Neurology remains a small specialty in the UK with approximately 270 adult neurologists and 38 pediatric neurologists. On average, there is one adult neurologist per 200,000 to 250,000 individuals. Recently, however, the specialty has been expanding rapidly. The specialty of epileptology is not well established. There are perhaps a dozen or more neurologists in the UK who claim a special interest or expertise in epilepsy. Epilepsy services, however, are often provided by neuropsychiatrists or clinical pharmacologists.

Epilepsy care. In outlining the pattern of care for patients with epilepsy, the descriptions that follow will draw on data derived from an unselected prevalent population of people with epilepsy in the Mersey Region of the UK.¹ Thirty-six randomly selected general practices were contacted after a stratification for size and geographical location; 31 practices agreed to participate. Patients who had a history of seizures in the previous 2 years or who took antiepileptic drugs (AEDs) because of a history of epilepsy were identified. Of the total practice population of approximately 170,000 people, …