What is primary care epileptology?

Abstract
Epilepsy is a chronic condition, needing long-term treatment to control seizures. Seizures can be controlled with anti-seizure medications (ASMs) of varying dosage and types, or tertiary care treatment such as sometimes adjusting dosage and multiple medications to do so. Although diagnosis requires specialist input (a hospital based neurologist), ongoing care can be delivered in primary care. People with epilepsy receive care that is led by neurologists, which is focused on treating symptoms, i.e. seizure control. However the impact of epilepsy also affects mental and physical aspects of daily life, justifying a whole person approach to people with epilepsy’s care.

Following various initiatives to include primary care in epilepsy management across the NHS, this thesis aimed to define a new framework for primary care involvement. The thesis research question ‘What is primary care epileptology?’ explored how epilepsy care can be effectively delivered in primary care. The thesis explored how redistributing care between specialists and generalists could be beneficial, focusing on how ‘general practitioners with an extended role’ (GPwERs) could be incorporated into current care for people with epilepsy. To do this, each chapter applied a model of generalism (‘The United Model of Generalism, Reeve and Byng, 2017) to epilepsy care. The mixed methods approach used triangulation to combine the findings across the thesis into a model of primary care epileptology.

The research has demonstrated how GPwERs are can play an important role in integrated yet interpretive care. In the process, defining accessibility for primary care epileptology. This demonstrates how the application of ‘The United Model of Generalism’ can be applied to epilepsy care. GPwERs are beneficial to people with epilepsy combining generalist care combined with specialist knowledge, resulting in patient centred approaches that can be tailored according to the complexity of patient needs.