The population of the United Kingdom, estimated to be 58.2 million in 1993, has been predicted to peak at 62.2 million by 2031,1 although recent projections have reduced that figure by at least a million.2 The recent reorganisation of The Health Service has emphasised the desirability of managing patients in the community and on an outpatient basis rather than in hospital. In England, for all specialties, the daily average number of available beds in 1983 was 343 000 compared with 220 000 in 1993-4.3 Over the same period, new outpatient attendance rose from 8 311 000 to 9 685 000. The falling number of beds has been offset by a substantial increase in throughput. In 1991-2 finished consultant episodes (defined as ordinary admissions combined with day cases) for diseases of the nervous system and sense organs (International Classification of Diseases-9th revision (ICD-9) codes 32-389) was 496 000, rising to 530 000 in 1993-4. This substantial increase in workload has been matched by increasing medical staffing levels. In England, all hospital neurological staff rose from 352 in 1983 to 446 in 1993, the consultant number rising, in the same period, from 146 to 186. The reverse process however, has occurred with nursing staff. Over the same period (1983 to 1993) their numbers fell from 374 851 to 344 503.3 By mid-1995, there were 250 consultant neurologists in England, Wales, Scotland, and Northern Ireland, amounting to one neurologist per 233 600 of the population.4

The diseases encountered in neurological outpatient practice have been analysed both in surveys undertaken by individual neurologists,5 6 and in those conducted among a cohort of neurologists.7 8 In the survey undertaken by the association of British Neurologists,8 16 conditions were found to constitute 74% of the outpatient’s workload (table). …