Migraine a huge burden on NHS services

September 9th 2015 ...in category Commissioning Excellence

A huge 6.7 million people in England suffer from migraine . According to the World Health Organization migraine is the leading cause of neurological disability, yet many people don’t realise what a debilitating condition it can be, and one that puts a big strain on our health economy too.

Four percent of adults will visit their GP each year for headache or migraine[i] and the cost to the NHS is over £1 billion a year[ii]. This excludes related costs for conditions like anxiety and depression, and the estimated £5 billion cost to our economy.[iii] No small problem.

Migraine can affect people in different ways – from very rare attacks to daily episodes of paralysis, confusion and pain that rob people of their independence. A large proportion of these people are not being managed effectively and the consequences are that 80% of migraineurs have disabling attacks that interfere with work, home and social life to some degree[iv].

Furthermore visits to A&E are not unusual for people with migraine or headache (in fact it is the most common neurological reason for A&E attendance[v]) normally because they can’t get the help they need elsewhere.

Currently services simply aren’t working efficiently: neurology clinics are overloaded, GPs don’t always have the expertise to deal with the range of headaches that present or they may refer patients to hospital just in case it’s something more sinister. The result of this is that A&E sees significant numbers of people with headaches that could be more effectively managed elsewhere. A&E is an expensive way of dealing with any problem; surely there is a more cost effective way to manage this group of patients?

Some areas have implemented dedicated headache clinics headed up by GPs with a special interest in headache. Services like this do a great job at reducing referrals to the neurology clinic. These types of services have adopted specially designed local headache pathways, supported by the neurology clinic when needs be, and show just what is possible when other health professionals like specialist headache nurses and opticians get involved in managing patients effectively away from neurologists.

If the whole of England operated on this model the gains could be enormous: patients would all have an accessible local GP or nurse they could call on for reassurance and expert advice, a smoother ride through the system, and clinical commissioning groups (CCGs) could manage patients more cost effectively.

So if we have models of good practice that we know could achieve cost savings and better patient outcomes, why aren’t they being replicated everywhere?

To really recognise the benefits that staff like specialist headache nurses offer commissioners have to get to grips with patient data to see where costs lie, which is something our needs assessment and business intelligence services can help with.

However, most commissioners have an alarming lack of understanding around local neurological populations and their needs, a point highlighted in the Neurological Alliance’s report published earlier this year called ‘The Invisible Patients’.

The report uncovered that many CCGs are not looking at basic data about how they need to commission services, such as how prevalent neurological conditions are in the area (only 26.2% of CCGs have assessed this). Only 20.4% of CCGs have assessed the number of people using neuro services, and astonishingly only 14.7% of CCGs have assessed local costs of providing neurology services.

With migraine and headache constituting such a large proportion of the strain on neurology services, not only is it essential to address this patient population’s needs, but it offers a quick win where cost efficiencies are concerned if commissioners can get headache services right.

[i] Latinovic,R, Gulliford M, Ridsdale L. ‘Headache and migraine in primary care: consultation, prescription, and referral rates in a large population’. Journal of Neurology Neurosurgery & Psychiatry 2006. 77 p385–387

[ii] Ridsdale, L., Clark, C., Dowson, A., Goldstein, L., Jenkins, L., McCrone, P., Morgan, M. & Seed, P. ‘How do patients referred to neurologists for headache differ from those managed in primary care?’ British Journal of General Practice 2007, 57, 538, p388 – 395

[iii] McCrone, P., Seed, P. T., Dowson, A. J., Clark, L. V., Goldstein, L. H., Morgan, M. & Ridsdale, L. ‘Service Use and Costs for People with Headache: a UK Primary Care Study’. Journal of Headache and Pain. Dec 2011, 12(6) p617-623

[iv] Steiner TJ. ‘Lifting the burden: the global campaign to reduce the burden of headache worldwide’. The Journal of Headache and Pain. 2005 6(5) p373-77

[v] The Health and Social Care Information Centre. Migraine. Copyright 2013, http://www.hscic.gov.uk/catalogue/PUB06348/hes-on-migr.pdf Accessed 23 October 2014

About the Author

Sue Thomas

Sue Thomas

Chief Executive for Commissioning Excellence

View more posts by Sue Thomas

September 9th 2015
...in category Commissioning Excellence

Commissioning Excellence

As one of NHS England’s recognised niche specialist commissioning support providers, we offer a full range services to assist you in improving patient outcomes. Our experience covers all long term conditions, with a particular specialism in the field of neurology.

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