Objective To describe current reasons and sources for new referrals to a neurology outpatient service, and ask is the pattern of referral appropriate?

Method Descriptive study of reasons for referral and source derived from 709 new referral letters received over 3 months in 2009 by a neurology department at an inner city hospital.

Results Complete data were available for 684 (96.5%) of referrals. Headache/migraine (21%) and epilepsy/loss of consciousness (20%) were the commonest reasons for referral, followed by peripheral neuropathy (14%), and pain (7%), with other specific causes accounting for <5% each. Almost two thirds of referrals were from non-local General Practitioners (32%) and from specialists (31%), with 37% from local GPs.

Conclusions Reasons for referral to neurology are similar to 20 years ago. Referrals for headache/migraine remain the most common, despite evidence that provision of headache services can be delegated to general practitioners with special interest in headache. The locality where the hospital is based has one of the highest rates of epilepsy death. Training and delegation could create capacity for neurologists to see patients, especially those at risk of death in epilepsy, where they may help improve outcomes.