National Institute for Health and Clinical Excellence (NICE)
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Call for GPs to investigate headache problems

GPs should be given direct access to CT scans to investigate patients who present with headache for any serious underlying problems, say researchers.

NICE Fellows Dr David Kernick, a GP, and Stuart Williams, a consultant radiologist,suggest that allowing GPs direct access to neuroimaging would help them to assess whether the headache is the result of an underlying cause, such as a brain tumour.

Writing in the British Journal of General Practice, they say that the move could help to save money by dramatically reducing the number of referrals made to secondary care.

Although only a small number of patients who present with headache will have a serious problem, headache is the most common cause of neurological referral to secondary care.

Previous studies have shown that patients who are referred to secondary care rather than being investigated at a GP surgery tend to consult more frequently and suffer from greater stress and anxiety.

They point to studies showing that giving GPs access to CT scans reduced the number of secondary care referrals by 86 per cent.

The authors argue that CT scans should be used for imaging as the incidence of false positives increases by almost two-fold when using MRI compared with CT.

CT is also cheaper and more readily available than MRI with lower waiting times.

Dr Kernick said: “Around 30 per cent of neurology referrals are for headache and many of these are inappropriate for this setting. The available evidence suggests that GPs can utilise brain imaging appropriately and reduce secondary care costs.”

They conclude that “the existing evidence suggests that GPs can refer for investigation appropriately and can reduce secondary care referrals.

“We suggest that GPs have direct access to CT unless headache patients present with associated neurological signs when urgent neurological referral is indicated.”

Dr Kernick and Mr Williams decided to investigate the issue of headache referral in primary care after meeting through NICE's Fellows and Scholars programme.

Set up in April 2009, the programme is designed to foster a network of NHS health professionals committed to improving the quality of patient care within their local health and professional communities, as well as supporting the core values that underpin NICE's work.

NICE is looking for more GPs to join the 2012 Fellows and Scholars Programme, as well as other influential professionals such as NHS managers, Trust Chief Executives, Medical and Finance Directors.

If you are interested in applying, please submit your application by Friday 25 November 2011.

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