In an attempt to demand manage the inexorable annual increase in neurology referrals our PCT introduced direct access to brain MRI for GPs in 2009. It was predicted that this strategy would ‘save £50 K’ and substantially reduce new patient referrals. GP guidelines were introduced but in spite of this there were some bizarre clinical indications including psychosis, neck pain and total body pain. Our department also received some unusual requests for information including whether it was safe to scan patients with dental fillings! Over a 12-month period 169 scans were performed. The predominant indication was headache and in 25% of cases this was migrainous. The majority of scans were normal or showed incidental white matter abnormalities. 3% of scans showed other incidental abnormalities including meningioma, stroke and anterior communicating artery aneurysm. One scan showed a probable symptomatic lesion (AVM) but unfortunately the patient died 4 days after the scan was performed. In spite of MR imaging 20% of patients were subsequently referred to the neurology clinic within 6 months of their MR appointment. The cost of these scans was approximately £73K with additional neurology appointments costed at £7K. A minor reduction in ‘new’ neurology referrals was demonstrated (5723 vs 5554) but cause and effect could not be established due to other factors (polling ranges, TALS etc). In summary it appears that allowing GP's direct access to brain imaging is not cost effective.
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