Neurology (NE)

  • Neurological presentations are an often complex challenge in general practice. These consultations require a nuanced approach; blending skilled history-taking, thorough examination, and appropriate clinical management, with an understanding of the broader psychosocial implications of neurological disease.
     
    Neurological conditions often emerge during a person’s working years, affecting not only the individual but also their family’s social and economic stability. The stigma surrounding neurological disorders and disabilities can vary significantly across cultures and communities, influencing how symptoms are perceived and discussed.

    General practitioners play a vital role in the early recognition, diagnosis, and support of patients with neurological conditions. This includes understanding referral pathways and being familiar with local and national resources available to support individuals living with neurological disability. Building collaborative links with neurology services, allied health professionals, and community organisations enhances patient care and helps GPs navigate the complexity of these often-challenging consultations. 

    • NE1. Demonstrate competence in assessing and managing common neurological conditions in all ages.
    • NE2. Perform an accurate and efficient neurological examination.
    • NE3. Recognise neurological red flags and manage them appropriately.
    • NE4. Manage neurological emergencies in primary care (such as stroke, meningitis, seizures, cauda equina and acute headache) ensuring timely referral, appropriate use of emergency pathways, and effective communication with secondary care.
    • NE5. Develop a basic understanding of the epidemiology and neuroanatomy relevant to common neurological conditions to support accurate diagnosis and management.
    • NE6. Communicate effectively with patients and families when managing neurological conditions, addressing concerns and sensitively discussing prognosis and treatment options.
    • NE7. Demonstrate empathy and compassion towards patients with disabling neurological conditions, with an understanding of the quality-of-life implications associated with such illnesses.
    • NE8. Care for patients with complex neurological conditions, including those with brain injury or severe mobility impairment, collaborating with specialist teams and support services.
    • NE9. Manage functional neurological symptoms by recognising the psychological contributors to symptoms such as headache or other neurological presentations and developing shared management plans with patients.
    • NE10. Demonstrate knowledge of current guidelines, resources, and legal considerations related to neurological conditions, including driving restrictions and patient safety regulations.

    For each problem or disease, consider the following areas within the general context of primary care:  

    • The natural history of the condition, including whether acute or chronic
    • The incidence and prevalence, including in different demographic groups
    • Typical and atypical presentations
    • Recognition of normal variations throughout life
    • Risk factors, including lifestyle, socio-economic and genetic factors
    • Diagnostic features and differential diagnosis
    • Recognition of ‘alarm’ or ‘red flag’ features
    • Appropriate and relevant investigations
    • Interpretation of test results
    • Management, including initial and continuing care, chronic disease monitoring and emergency care
    • Patient and carer information and education
    • Prognosis

    Signs, Symptoms & Presentations

    • Acute Confusion
    • Athetosis
    • Chorea
    • Cognitive Impairment
    • Dizziness
    • Facial Weakness
    • Gait disturbance
    • Headache
    • Language Deficits
    • Muscle Weakness
    • Neuralgia
    • Neuropathic Pain
    • Nystagmus
    • Paraesthesia
    • Ptosis
    • Pupillary Abnormalities
    • Seizure
    • Sensory Disturbance
    • Spasticity
    • Speech deficits
    • Syncope
    • Tremor
    • Visual Disturbance
    • Visual Field Defects

    Common and Important Conditions

    • Autonomic Neuropathy
    • Bell’s Palsy
    • Brain Aneurysm
    • Cauda Equina
    • Cerebellar Syndrome
    • Cerebral Palsy
    • Cluster Headache
    • Complex Regional Pain Syndrome
    • Concussion
    • Dementia
    • Demyelination
    • Dystonia
    • Encephalitis
    • Epilepsy
    • Extradural Haemorrhage
    • Functional Neurological Disorders
    • Guillain Barre Syndrome
    • Head Injuries
    • Huntington’s Disease
    • Idiopathic Intracranial Hypertension
    • Meningitis
    • Migraine
    • Mononeuropathies
    • Motor Neuron Disease
    • Multiple Sclerosis
    • Muscular Dystrophy
    • Myasthenia Gravis
    • Parkinson’s Disease
    • Parkinsonism
    • Peripheral Neuropathy
    • Polyneuropathies
    • Restless Leg Syndrome
    • Spinal Cord Disorders
    • Spinal Injuries
    • Stroke
    • Subarachnoid Haemorrhage
    • Subdural Haemorrhage
    • Tension Headache
    • Transient Ischaemic Attack
    • Transverse Myelitis
    • Trigeminal Neuralgia
    • Tumours of the brain and peripheral nervous system
    • Venous Sinus Thrombosis
  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed Learning

    Blended Learning Resources (Education Platform)

    Adult Epilepsy in GP

    Workplace Based Learning

    Neurology is best learned in the workplace by actively engaging with real patient encounters across a variety of clinical settings. Observing and participating in consultations helps develop essential skills in neurological history taking, examination, and clinical reasoning, supported by timely feedback from experienced clinicians. When trainees clerk patients in the medical hospital, they should get used to carrying out neurological examinations on every patient so that they are familiar with what is normal and what is abnormal. If your local hospital has a neurology department, consider reaching out to a registrar or consultant who can guide you through focused neurological examinations in order to prepare for general practice. In centres with a stroke unit, spend time on the stroke ward to gain confidence in both acute and long-term stroke management, including prevention strategies and the GP’s role as a potential first responder in the community. If available, attending a headache clinic can also provide valuable insight into the assessment and management of one of the most common neurological presentations in primary care.

    Day Release

    Day release sessions provide an excellent opportunity to deepen understanding of neurology in a structured, supportive environment. These sessions can be used to explore common neurological presentations in primary care (such as headaches, seizures, dizziness, and functional symptoms) through case-based discussions, peer learning, and teaching from experienced GPs. Day release also allows space for reflection on complex consultations and for identifying gaps in knowledge or skills to follow up on in clinical practice.

    Registrar Tutorials

    Registrar tutorials are an ideal setting to explore neurology in greater depth, tailored to the specific learning needs of the trainee. These sessions can cover both common and challenging presentations (such as blackouts, tremors, neuropathies, and functional symptoms) using case discussions, problem-solving exercises, or focused teaching on examination skills. Tutorials also provide a safe space to ask questions, clarify clinical uncertainties, and discuss diagnostic reasoning. Tutorials should aim to build confidence in recognising red flags, knowing when to refer, and managing neurological conditions in the community.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

    EPA 9: Manage the care of adults, including older people with acute presentations

    A patient presenting with sudden onset unilateral weakness provides an opportunity to demonstrate EPA 9. If the GP Trainer observes the consultation and examination, including neurological assessment and recognition of stroke red flags, a PIP-C and PIP-P can be used to provide feedback on diagnostic reasoning and appropriate activation of emergency referral pathways. A succinct case entry could be: “assessment of acute stroke symptoms in older adult.” Reflection could explore timely identification of neurological emergencies, effective communication with patients and families about prognosis and next steps, and clear documentation of the assessment.

    Core Knowledge Test (CKT)

    • Assessment of ataxia

    • Management of Migraine

    • Interpretation of neurological symptoms and signs

    Clinical Competency Test (CCT)

    • A patient with symptoms suggestive of concussion.
    • A patient presenting with numbness and paraesthesia intermittently in their left arm.
    • A patient presenting with headaches.

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.