Have the New GP Contract and NICE guidelines improved the clinical care of people with epilepsy?

PURPOSE This retrospective audit was to assess the effect of the New General Practitioner (GP) Contract and National Institute for Health and Care Excellence (NICE) guidelines on the care and management of people with epilepsy (PWE) during the period of observation from April 2004 to April 2009. METHOD The case notes of 540 people on anti-epilepsy drugs (AEDs) aged 16 years were reviewed in 13 general practices serving Ellesmere Port and Neston. RESULTS Forty-nine percent of people with poorly controlled epilepsy were not under shared care. Diagnostic doubt existed in 25 (5%) people. There was no evidence that the original diagnosis had been actively reviewed by the GP in any case. There were 98 (18%) women of childbearing age, in 21 of whom there was no evidence of pre-conceptual counselling ever having taken place, and 61 (62%) were not receiving folic acid routinely. Thirty-nine (7%) people were demonstrably non-compliant, whilst 74 (14%) people had prescription anomalies consisting mainly of inappropriate multi-dose regimens. CONCLUSION Despite marked improvements in review rates after the introduction of the New GP Contract five years previously, there are still significant unmet needs in this patient group. Clinical Commissioning Groups (CCGs) should consider funding an intermediate tier of care incorporating GPs with a special interest in epilepsy (GPwSIes) and Epilepsy Nurse Specialists (ENS) for PWE to improve and maintain existing and future primary care, as epilepsy is phased out of the Quality and Outcomes Framework (QOF).