According to a respected Dutch neurologist, the UK has a ‘limited definition of neurology’ (J van Gijn, personal communication). In contrast with most of the rest of Europe, UK neurologists don't generally manage stroke, dementia, some of Parkinson's disease or head injury. It is also one of the few countries in Europe where acute neurological emergencies are not routinely seen by a neurologist on admission. Why is it accepted practice that while acute gastrointestinal emergencies are assessed and treated by gastroenterologists, acute neurological emergencies, which are more frequent, do not have easy and prompt access to expert neurological opinion?

One of the reasons often given for these striking differences is the relative lack of neurologists in the UK compared with some other countries. For example, in Holland there is one neurologist per 20 000 population compared with one per 150 000 in the UK.1 But the differences in the pattern of service provision are also to do with how neurology is organised with practices and attitudes that are now out of date, particularly the long established hub and spoke model—that is, a regional neurology centre providing intermittent outpatient and ward consultation services to one or more surrounding district general hospitals (DGHs).

What are the consequences for patients? If you have a serious acute neurological disorder requiring admission to hospital, your chances of seeing a neurologist early are small. …