Outpatient adult neurology in England is growing rapidly, increasing from 235 000 new appointments in 2003–2004 to 396 000 in 2008–2009. It is serving a greater proportion of the population, increasing from 5.8 new appointments per 1000 population (over 15 years old) in 2003–2004 to 9.5 in 2008–2009. Follow-up appointments also increased over the same period from 14.1 to 21.2 per 1000 population. The chance of attending a new appointment in neurology varies according to age, sex and address. The most likely person in England to see an NHS neurologist in 2008–2009 was a 50 to 55-year-old woman living in Plymouth. Areas previously relatively under-served have improved; Plymouth, for example, has risen from 167th (of the then 302 PCTs) in 2003 to first (of the 152 PCTs now) in 2008. Other areas have fallen behind. The chance of being seen in neurology outpatients in England still varies by PCT of residence by a factor of four. Demand in 2003’s highest referring PCTs continues to grow. Despite ongoing and massive service expansion a ceiling in outpatient number has not been reached and the postcode lottery of neurology outpatients continues.
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