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| Every physician should have an understanding of the general principles of management and should also be aware of when and where to refer |
| if more specialist advice is needed in the areas shown below |
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| Exposure to people with long-term neurological conditions | (i) Understanding disease progression and prognosis |
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| Symptom control | (i) Ability to control key symptoms including:
(1) pain in neurological conditions
(2) breathlessness
(3) nausea/vomiting
(4) anxiety/depression
(5) spasticity management
(6) 24 hour postural support
(7) Bladder and bowels
(8) Seizure control |
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| Communication | (i) Basic understanding of common communication problems including dysphasia, dysarthria, cognitive speech disorders, and the different approaches to their management.
(ii) Ability to communicate with people who have cognitive/communication impairments
(1) using assistive communication devices
(iii) Communicating with patient and family
(1) breaking bad news
(2) addressing end of life decisions and advance care planning which will include choice over place of care.
(3) Managing expectations. |
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| Legal issues | (i) Ability to assess for mental capacity and to assist people to make advance decisions and statements.
(ii) Understanding of the Mental Capacity Act 2005 and ability to work alongside lasting power of attorney/court appointed deputy or independent mental capacity advocates. |
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| Additional skills for physicians specializing in neurological palliative care and rehabilitation |
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| Specialist interventions | (i) Local and intrathecal interventions for spasticity (e.g., injection of botulinum toxin/phenol and use of baclofen pumps).
(ii) Specialist procedures for pain control.
(iii) Management of confusion/unwanted behaviours–management under sections of the Mental Health Act 1983
(iv) Ventilation |
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| Specialist equipment | (i) Wheelchair seating systems
(ii) Environmental control systems
(iii) Specialist communication aids |
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| Counselling and psychological support | (i) Dealing with loss and fear of loss
(ii) Spiritual support
(iii) Bereavement–past and future |
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| Welfare advice | (i) Understanding the social care system and benefits
(ii) Vocational support |
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| Additional sources of help and support | (i) Understanding the interaction between health, social services and voluntary support agencies
(ii) Negotiating skills in obtaining services |
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