Improving the journey from symptom onset to diagnosis for people with neurological conditions

Powys Teaching Health Board

Michelle Price, Clinical Lead, Neurological Conditions Implementation Group

Rhiannon Edwards, Neurological and Rare Diseases Implementation Groups Coordinator


The Neurological Conditions Implementation Group (NCIG) has recognised that there are significant delays in getting a diagnosis for people in Wales who experience neurological symptoms. This has been exacerbated by the Covid-19 pandemic and the difficulty recruiting to consultant neurologist posts. This can result in significant distress to those who are awaiting a diagnosis, increases in unplanned admissions and emergency department attendances, delays in treatment and potentially worse outcomes for patients. Service users across Wales have highlighted their frustration at the time it takes to get a diagnosis of a neurological condition and the impact this has on their lives. Focusing on improving this first element of the patient journey has potential to improve outcomes for people with neurological conditions and release capacity in the system to enable further service improvements.


How might we reduce (specific) the time (measured) from neurological symptom recognition in primary care to referral to diagnosis (achievable) in a designated area by 10% (realistic) in 6 months (targeted).


  1. Collate data on current waiting time and pathways from primary care referral to diagnosis
  2. Explore patient experience of journey to diagnosis to inform gaps in service provision
  3. Investigate opportunities to impact on the delays and quality of care provided to the patient
  4. Develop resources to support the improved outcomes for patients

Expected Benefits

  • Improve equity of access
  • Significantly reduce referral to diagnosis time,
  • Improving service user experience and outcome
  • Reduce demand on already overstretched neurology services
  • Reduced unplanned admissions and attendances at A&E
  • Offer opportunity to develop workforce of specialist nurses and AHPs to support to support the neurologists to provide investigations, assessment and improve management of conditions