HHE Neurology supplement 2018 - Page 8

poses significant risks to health, being associated with a high incidence of serious bone marrow suppression and heart rhythm abnormalities, either of which can be fatal. The mitigation of risk of clozapine treatment therefore requires the provision of a regular monitoring service, with weekly blood samples forwarded to the monitoring service. The drug is usually dispensed weekly or fortnightly only on receipt of a satisfactory blood sample. The establishment of such monitoring requires close collaboration between the pharmacy, nurse specialist and primary care. The challenges of commissioning and providing services for Parkinson’s The 2017 NICE guidance now underlines the multi-disciplinary nature of care in Parkinson’s. Physiotherapy, occupational therapy, speech and language therapy, dietician, pharmacist, and neurosurgeon are now all involved. The old model of a Consultant Neurologist or Geriatrician sitting in a clinic seeing a list of patients who have waited for many months for the privilege of being seen once and discharged promptly to the care of a GP no longer works. Patients and their carers now are entitled to, and expect, a comprehensive and responsive quality service provided from diagnosis to death. The management of chronic neurological diseases has become a major challenge to the NHS and commissioners and providers of neurological services can find that there are conflicts between primary and secondary care as to who takes responsibility for service provision and continuing care. Neurology services in secondary care may not be designed to provide continuing care, and primary care services, already overwhelmed by demand, may struggle with the complexities of neurological treatment and support. In this context, it is useful to start with the NICE quality statements on Parkinson’s disease when designing services (Box 1). As Consultant staff in the NHS are poorly accessible because of the scarcity of that resource and workload demands, adheren 6RF4RwVF6RW7Vǐ&WV&W2&vfV6VBW'6r2vV2VF6v&f&6R7B7V6Ɨ7B6VG&W2&V6v6RFPgVFVFfVRb&6>( W'6P7V6Ɨ7B&W6W&6R&FW"F&fFRFWVFRB&W76fR6W'f6RFFVG2F027'V6F&fFR6V6VƖrFGf6RG&VFVBƖ6R&WGvVV&'B6V6F'6&R6v7BFFW"FV2vW&R&WV&VB6&FFR6&RBFG&W72&&V2B7&6W2FW6fR'FB&R6&R`FRFVBVFW&vr7W&vW'f"&6( 2&V7FfRFV7G&FbFRfVR`&6( 27V6Ɨ7BW'6r6W'f6W22Fff7V@BV6bFRV&Ɨ6VB&W6V&62&vVǐV6FF'WBB2&VVW6&ǒ7VvvW7FV@FBW'6R7V6Ɨ7B6W'f6W2&VGV6RVV@F֗762BVwFb7F2vV0f6ƗFFrFW&V6RF4RwVF6RW'6R7V6Ɨ7B6W'f6W2fRF&RvVFW6vVBBvVBVffV7FfRW'6p6W'f6RW7B&R&W6ƖVBFB2BFWVFV@6vRFfGV’vVw&6ǐ6&VV6fRFB266WFrFVG2g&ЦFVfVB6ƗFW2vFWBvVw&6v2@f6ǒ6VBB6&R6FVB&' 6V6F'6&RBV6FV2GfFvW0BF6GfFvW26W'f6W26&R67BVffV7FfP6V6F'6&RbgVFVB'Fǒ"&vVǒF&fb6Rg&W'6RVB6Ɩ72FVF@r6RfW&ƗGf"6W'f6W2Fw&pvFFVBFVB&'6&R6W'f6P&f6W72FWVFVB6Ɩ26R@FW&Vf&R&RfW&RF&fFR6W'f6W2FPFVG>( W2'WBgFV&VƖBgVFpg&( &66G&7N( FB&W7VB6W'f6W0FB&V6RV7F&RbFW6B&W7BF7&V6r6W'f6RFVG2B2&VVW7FFV@FB&6( 2W'6W2&R67B6frFRT'WBFRFVv26V6FfRFFR6'@FFF67G2bFW"VF&fW76>( FR"6֗76W'2fRF&RW'BFFP6vrFVG2FVw&FVB6W'f6W2@vB6V6F&WGvVV&fFW'2@6֗76W'22FF'FF֗6R&f66&RbFVG2F֗GFVBF7FvF&6( 22rg&WVVFǒ&V6v6VB07V&F&V6VB6v( vWBBF^( 'FR7W'B6&G&6( 2TV66V@FRVVBFvWBVF6FFRFf@fV7GVF6Ɩ67FFRv6&W7V@FVVBF66&vR"fF&R&&FGf"WRg&f2"6gW6F20&V6v6VB4RwVF6RBFRVƗG7FF&Bf"&6( 2FR&&VbvrF&rbFVG0vF6&2WW&v6F6V6R2vW&P&WGFW"W7G&FVBFvF&6( 2F6V6RFVG2&Rf6VBvF&w&W76fRF6&ƗG@&WV&R7&VVF7W'BBFR6FFগ26&7FW&6VB'fV7GVFB7&62FB6&RfW'FVBǒ'&BGFVF6RG'Vw0W6VBFR6FF'F7V&ǒ6R&WV&RFRW7F&Ɨ6VBbf6fR@66W76&RF&r77FV2v6W7Vǐ&WV&R66R6&&F&WGvVVVFPvV6W2&'B6V6F'6&R6VFpVF6W'6rB&7vR76G&0VG2&Rf֖Ɩ"vFFRW6R@F&rb6RFVG2FP6VG2B2G'VrgFVW6VBf &Vg&7F'766276G&7G2&R&&Vǐf֖Ɩ"vFFR'F7V"6VvW2bG&VFpFVG2vF&6( 2v&RfW'V6&R6V6FfRFFRGfW'6RVffV7G2`F76F2VF6FF7BFVG2vF66&V&VƖ6RWFVFrW7Fp6֗76VB6W'f6W2f"6RFBW7@FRVFVF6W'f6W2FW&Vf&R&P֗76VB27V66W'f6W2BfRFPV6W76'WW'F6RFvRFR6Ɩ66VvW266W60FR&f6b6Ɩ66W'f6Rf"FVG0vF&6( 2F6VR6ƖBvF4PwVFVƖW22"6VvRf"琦&v6F&WV&rFVw&Fb6W'f6W07&72&'B6V6F'6&RB67&70W'6rFW&BVF6F66ƖW2FVG0&WV&Rf&FB7W'Bg&FRV&ƖW7@7FvW2FFR7BFbƖFfR6&RBFW&P&R'F7V"&&V2f"f֖ƖW2B6&W'2VW&vV76&RBGW&Fb7FƗ6F6ƖVǒ&R֖֗6VB'W6VVB6&Rg&ЦvVVBFVFR6VvW2f"VFW'6BvVVBbFRFV2&R66FW&&RࣀR#7FƆVF6&R6Х&VfW&V6W0F7FGWFRf"VFB6&RW6VV6R&6( 0F6V6RGVG24RwVFVƖPssVǒ#rwwr6R&rVwVF6Rss66W76V@&#"FR6FV6RB&WfV6Pb&6( 2FRT&W7VG0g&FR6Ɩ6&7F6P&W6V&6FFƖ7V'&W'B#rwwr&62&rV6FW2FVfVBfW2#У53#cS#6FV6RS#BS#&WfV6RS#&W'BS#'&FrS#7V'S#&W'BF`66W76VB&#2F7FGWFRf"VFB6&RW6VV72&6( 0F6V6R( 2VƗG7FF&@3cEfV''V'#wwr6R&rVwVF6R3cB6FW"VƗG7FFVVG066W76VB&#B766Fb'&F6WW&v7G27WFRWW&w6W'f6W27W'fW#rwwrFV&&rVFF7VVG27WFRS#WW&w$S#7WFRS#WW&wS#7W'fWS#fS#2S#&6S##rFb66W76V@&#R&VfW'&FG&VFVC'VW0BwVF6R4R#PGG3wwrVvB2V&W6W&6W2'GBbf&fV6$&VF"FFW&&W67F@7F2&6( 2F6V6RढWW&G&6fV#c#3( 33r2VvB6Ɩ66֗76rƖ77FFVVC66&VFFW7FvVGVFVǐ#RwwrVvB2V6֗76rw6FVBWG26FW2"#RrCBЧRFb66W76VB&#ࣂF7FGWFRf"VFB6Ɩ6W6VV6RFWWvF֖R&f7Fv֖RBVFPFRG&VFVBbǦVW.( 0F6V6R4RFV6w&6wVF6RD#u#wwr6R&rVwVF6RF#r6FW"BWfFV6RBЦFW'&WFF66W76V@&#࣒vFVB26ԢƖFfR6&R