Diagnosing Parkinsons

The request was partially successful.

Dear National Institute for Health and Care Excellence,
Can a Medical consultant diagnose, investigate treat Parkinson’s patients and movement disorder patients ? Since according to some websites (https://www.bgs.org.uk/resources/parkins... )
It says “ Specialists in Geriatric Medicine who are trained and experienced in managing complex problems in the elderly are well placed to carry out this function.”

Nice suggests (https://www.nice.org.uk/guidance/ng71/if... )
“If you have problems with some or all of these things, and your GP suspects Parkinson's disease, they should refer you to a specialist – either a neurologist or a geriatrician.
A neurologist is a healthcare professional who specialises in disorders of the brain, spinal cord and nerves, and a geriatrician is a healthcare professional who specialises in disorders that affect older people.”

So can you let me know if a general medical consultant who is not a specialist geriatrician nor a neurologist can manage Parksinons patients?

Yours faithfully,

dutta

National Institute for Health and Care Excellence (NICE), National Institute for Health and Care Excellence

Dear Dutta,

 

Reference No: EH-304732

 

FREEDOM OF INFORMATION ACT 2000

 

Thank you for your request, sent to our office on Tuesday 28 January 2020,
in which you asked NICE for the following information:

 

Can a Medical consultant  diagnose, investigate treat Parkinson’s patients
and movement disorder patients  ? Since according to some websites
([1]https://www.bgs.org.uk/resources/parkins... )
It says “ Specialists in Geriatric Medicine who are trained and
experienced in managing complex problems in the elderly are well placed to
carry out this function.”

Nice suggests 
([2]https://www.nice.org.uk/guidance/ng71/if...
)
“If you have problems with some or all of these things, and your GP
suspects Parkinson's disease, they should refer you to a specialist –
either a neurologist or a geriatrician.
A neurologist is a healthcare professional who specialises in disorders of
the brain, spinal cord and nerves, and a geriatrician is a healthcare
professional who specialises in disorders that affect older people.”

So can you let me know if a general medical consultant who is not a
specialist geriatrician nor a neurologist can manage Parksinons patients?

 

 

Your request will now be considered and you will receive a response within
the statutory timescale of 20 working days as defined by the Act, subject
to the information not being exempt or containing a reference to a third
party. In some circumstances we may be unable to achieve this deadline. If
this is likely you will be informed and given a revised time-scale at the
earliest opportunity.

 

There may be a fee payable for the retrieval, collation and provision of
the information you request. If this is the case you will be informed and
the 20 working day timescale will be suspended until we receive payment
from you. If you chose not to make a payment then your request will remain
unanswered.

 

Some requests may also require either full or partial transference to
another public authority in order to answer your query in the fullest
possible way. Again, you will be informed if this is the case.

 

I would like to take this opportunity to thank you for your interest in
NICE.

 

Yours sincerely,

Natalie

 

Communications Executive

Corporate Communications

National Institute for Health and Care Excellence
Level 1A | City Tower | Piccadilly Plaza | Manchester M1 4BT | United
Kingdom

Tel: 0300 323 0141 | Fax: 0300 323 0149
Web: [3]http://nice.org.uk

 

 

 

show quoted sections

National Institute for Health and Care Excellence (NICE), National Institute for Health and Care Excellence

 

Dear Dutta,

 

Reference No: EH-304732

 

FREEDOM OF INFORMATION ACT 2000

 

Thank you for your request, sent to our office on Tuesday 28 January 2020,
in which you asked NICE for the following information:

 

Can a Medical consultant  diagnose, investigate treat Parkinson’s patients
and movement disorder patients  ? Since according to some websites
([1]https://www.bgs.org.uk/resources/parkins... )
It says “ Specialists in Geriatric Medicine who are trained and
experienced in managing complex problems in the elderly are well placed to
carry out this function.”

Nice suggests 
([2]https://www.nice.org.uk/guidance/ng71/if...
)
“If you have problems with some or all of these things, and your GP
suspects Parkinson's disease, they should refer you to a specialist –
either a neurologist or a geriatrician.
A neurologist is a healthcare professional who specialises in disorders of
the brain, spinal cord and nerves, and a geriatrician is a healthcare
professional who specialises in disorders that affect older people.”

So can you let me know if a general medical consultant who is not a
specialist geriatrician nor a neurologist can manage Parksinons patients?

 

We interpret that you are requesting information that clarifies the type
of medical professional that should

o investigate and diagnose Parkinson’s disease, and
o manage the care of a patient with the condition.

 

The Freedom of Information Act relates to recorded information held by a
public authority, at the time of the request. Please find below our
response to your request. Additional background information has also been
included (provided outside the scope of the FOI Act) in order to be
helpful.

 

Response

 

NICE holds some information relevant to the scope of your request.  

 

Relevant information can be found within the guideline on [3]Parkinson’s
disease in adults (NG71). This guideline contains information that
discusses the professionals involved in the diagnosis and management of
people with Parkinson's disease. The guideline is accessible from the NICE
website (previous hyperlink). We therefore consider it to be exempt from
disclosure under Section 21 of the Act, since we consider it to be
information that is reasonably accessible to you.

 

If you have any questions on this response you are welcome to call me on
the enquiry handling team number: 0300 323 0141 (weekdays 09:00 – 17:00).

 

If you are unhappy with this response and want an internal review of how
we handled your request, you must write to us within 40 working days of
our response. Send your request to: Associate Director, Corporate Office,
National Institute for Health and Care Excellence, 10 Spring Gardens,
London SW1A 2BU or email: [4][email address]. When we receive your
request we will send you an acknowledgement within 5 working days.

 

The Associate Director, Corporate Office, will review your complaint and
send you a full reply usually within 20 working days. If you are
dissatisfied with the outcome of this review, you can apply directly to
the Information Commissioner for a decision at: The Information
Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9
5AF.

 

Additional background information provided outside of the remit of the FOI
Act

 

NICE guidelines contain recommendations on the best care and treatment
that should be available on the NHS, based on a review of the clinical and
cost-effectiveness evidence and following consultation with stakeholders.
The recommendations are advisory rather than mandatory.

 

The NICE guideline on Parkinson’s disease in adults (NG71) covers
diagnosing and managing Parkinson's disease in people aged 18 and over.
Please refer to our website to look over our [5]recommendations in full.

 

The background to our recommendations can be found in the [6]full
guideline document. This is a very large document which not only contains
NICE’s final recommendations to the NHS but which:

o includes discussions of the current standard clinical care (for
background information),
o highlights the uncertainties/key questions to be considered and
addressed by the guideline developers,
o contains details of the evidence that was considered, and
o shows the considerations of the guideline developers when formulating
the final recommendations.

 

In terms of investigating and diagnosing Parkinson's disease, NICE
recommends that if Parkinson's disease is suspected, people should be
referred quickly and untreated to a specialist with expertise in the
differential diagnosis of the condition (see recommendation 1.2.2).

 

The background to this recommendation can be found discussed in section
5.2 of the [7]full guideline document, within a section titled ‘Expert
versus non-expert diagnosis' (see pages 45). This background information
explains that: “The diagnosis of Parkinson’s disease could be made in
primary care by the person’s GP or in secondary care by a neurologist,
geriatrician or general physician. More recently, PDNSs and other health
professionals are developing diagnostic skills. Each may have different
levels of expertise in evaluating people with possible Parkinson’s
disease. The guideline developers therefore considered the following
question when developing the guideline: What is the evidence that someone
with special expertise is more accurate in diagnosing Parkinson’s disease
than someone with little experience?”.

 

Please note that PDNS stands for Parkinson’s disease nurse specialist.

 

Section 5.2.3 of the full guideline document discusses the evidence that
was considered. It states that the studies considered provide only
circumstantial evidence on the diagnostic ability of experts versus
non-experts. However, they show that the diagnosis of Parkinson’s disease
is wrong in around 47% of community-ascertained cases, 25% of non-expert
secondary care diagnosed cases, and 6–8% of cases diagnosed by an expert
in movement disorders. Since medication can mask the symptoms and signs of
Parkinson’s disease, the guideline developers felt that people with
suspected Parkinson’s disease should be referred before treatment is
commenced. This can be achieved only if people are seen quickly by
experts, for an accurate diagnosis and commencement of treatment, if
necessary.

 

The guideline NG71 contains different recommendations regarding specialist
involvement relating to both the pharmacological and non-pharmacological
management of motor and non-motor symptoms. It also includes
recommendations regarding the management and monitoring of impulse control
disorders as an adverse effect of dopaminergic therapy.

 

With regards to the pharmacological management of motor and non-motor
symptoms, the guideline includes various recommendations about the
involvement of healthcare professional with specialist expertise in
Parkinson's disease. (For example, when the person’s symptoms change, the
guideline recommends that advice should be sought from a healthcare
professional with specialist expertise in Parkinson's disease before
modifying therapy). Please see [8]recommendations 1.3.4, 1.3.9, 1.5.1,
1.5.3, 1.5.15, 1.5.28.

 

With specific regards to the management and monitoring of impulse control
disorders as an adverse effect of dopaminergic therapy and seeking the
advice from a healthcare professional with specialist expertise in
Parkinson's disease, please see [9]recommendations 1.4.6.

 

With regards to the non-pharmacological management of motor and non-motor
symptoms, the guideline makes specific recommendations referencing
specialist involvement.  Please see [10]recommendations 1.7.1 and  1.7.10.

 

The guideline also contains a section on ‘communication with people with
Parkinson's disease and their carers’ (section 1.1) which recommends that
people with Parkinson's disease should have a comprehensive care plan
agreed between the person, their family members and carers (as
appropriate), and specialist and secondary healthcare providers. It also
says that people with Parkinson's disease should be offered an accessible
point of contact with specialist services, and clarifies that this could
be provided by a Parkinson's disease nurse specialist (PDNS). (Please see
[11]recommendations 1.1.5 and 1.1.6)

 

While NICE guideline recommendations are arrived at after careful
consideration of the evidence available, the recommendations are not
mandatory. When exercising their judgement, professionals and
practitioners are expected to take NICE guidelines fully into account,
alongside the individual needs, preferences and values of their patients
or the people using their service. Professionals and practitioners are
ultimately responsible for making decisions appropriate to the
circumstances of the individual, in consultation with them and their
families and carers or guardian. In addition, the commissioning and
implementation of guideline recommendations by local NHS organisations can
differ depending on local populations and the resources they have
available.

 

Kind regards,

Natalie

 

Natalie Whelan

Communications Executive

National Institute for Health and Care Excellence
Level 1A | City Tower | Piccadilly Plaza | Manchester M1 4BT | United
Kingdom

Tel: 0300 323 0141 | Fax: 0300 323 0149
Web: [12]http://nice.org.uk 

 

 

 

 

 

From: National Institute for Health and Care Excellence (NICE)
Sent: 29 January 2020 09:44
To: '[FOI #639601 email]'
<[13][FOI #639601 email]>
Subject: RE: Freedom of Information request - Diagnosing Parkinsons (ref
EH-304732)

 

Dear Dutta,

 

Reference No: EH-304732

 

FREEDOM OF INFORMATION ACT 2000

 

Thank you for your request, sent to our office on Tuesday 28 January 2020,
in which you asked NICE for the following information:

 

Can a Medical consultant  diagnose, investigate treat Parkinson’s patients
and movement disorder patients  ? Since according to some websites
([14]https://www.bgs.org.uk/resources/parkins... )
It says “ Specialists in Geriatric Medicine who are trained and
experienced in managing complex problems in the elderly are well placed to
carry out this function.”

Nice suggests 
([15]https://www.nice.org.uk/guidance/ng71/if...
)
“If you have problems with some or all of these things, and your GP
suspects Parkinson's disease, they should refer you to a specialist –
either a neurologist or a geriatrician.
A neurologist is a healthcare professional who specialises in disorders of
the brain, spinal cord and nerves, and a geriatrician is a healthcare
professional who specialises in disorders that affect older people.”

So can you let me know if a general medical consultant who is not a
specialist geriatrician nor a neurologist can manage Parksinons patients?

 

 

Your request will now be considered and you will receive a response within
the statutory timescale of 20 working days as defined by the Act, subject
to the information not being exempt or containing a reference to a third
party. In some circumstances we may be unable to achieve this deadline. If
this is likely you will be informed and given a revised time-scale at the
earliest opportunity.

 

There may be a fee payable for the retrieval, collation and provision of
the information you request. If this is the case you will be informed and
the 20 working day timescale will be suspended until we receive payment
from you. If you chose not to make a payment then your request will remain
unanswered.

 

Some requests may also require either full or partial transference to
another public authority in order to answer your query in the fullest
possible way. Again, you will be informed if this is the case.

 

I would like to take this opportunity to thank you for your interest in
NICE.

 

Yours sincerely,

Natalie

 

Communications Executive

Corporate Communications

National Institute for Health and Care Excellence
Level 1A | City Tower | Piccadilly Plaza | Manchester M1 4BT | United
Kingdom

Tel: 0300 323 0141 | Fax: 0300 323 0149
Web: [16]http://nice.org.uk

 

 

 

show quoted sections