Aims To reduce referrals to the visiting neurologist by internally triaging the referrals by the two newly appointed consultants with an interest in neurology who could see some referrals inhouse. This in turn would lead to a more cost effective service, decreased waiting times and NICE guidance on epilepsy and best practice being followed.

Methods Approximately 60 referrals per annum are made to the- neurologist from primary, secondary (eg general and community paediatrics) and tertiary (eg Genetics) care. 20 outstanding referrals were reviewed by the consultants with an interest in August 2016. By introducing referral criteria based on best practice and NICE guidance in neurology and epilepsy the suitability of the patients for secondary interest or tertiaryclinics was determined. In-house bi-weekly epilepsy and neurology clinics, monthly first seizure and twice weekly telephone clinics were set up to ensure capacity and patient access to regular support and advice. A checklist for Epilepsy patients was produced to ensure that NICE was being followed in the new service. Any efficiency savings of reducing the visiting neurologist sessions was assessed.

Results Of the 20 patients awaiting appointments, 13 did not meet the criteria for review by tertiary neurology. Therefore, from 1 October 2016 the neurologist sessions were reduced to half and 13 referrals were sent back for local triage of which only 3 met the criteria for tertiary services. All 13 patients were then seen within 1 month of being triaged due to increased local capacity and freeing up the neurologist to see appropriate patients as per best practice and NICE guidance. This represented a significant reduction from the previous 6 months waiting time. By reducing the neurologist sessions £12 000 of efficiency savings per annum were made. Conclusions By internally triaging all neurology referrals and utilising consultants with an interest this has led to a more effective, efficient service which has cut waiting times while still following best practice and NICE guidance. Measures have been introduced such as referral criteria and an Epilepsy checklist which will ensure that standards are maintained.