Principal Investigator: Professor Chris Kipps, Consultant Neurologist at University Hospital Southampton NHS Foundation Trust

Research team: Patricia Fuller, Sarah Fearn, Sally Dace, Amanda Wollam, Angeliki Zarkali, Adam Cowan, Sam Mountney, Georgina Carr, Sofia Eriksson

Starts: 1/2/2022

Ends: 31/07/24

Background

Remote consultations are now a routine part of neurology outpatient care. Their rapid expansion during the COVID-19 pandemic demonstrated clear benefits, including greater convenience, reduced travel, and improved flexibility for patients and carers. However, it also exposed important challenges relating to clinical assessment, communication, privacy, digital access, and service organisation.

While national policy strongly supports digital innovation and outpatient transformation, there has been limited evidence on how best to combine face-to-face, telephone, video, and digital communication in everyday neurology practice.

REMOTE-Neuro was developed to address this gap by combining national-scale data with co-production to generate a practical, evidence-based framework for optimising hybrid care.

Why this research matters

Remote care has become embedded in the NHS faster than the evidence and systems needed to support it. At the same time, national strategies promote hybrid care, patient choice, and digital inclusion, but offer limited practical guidance on how to translate these ambitions into real-world outpatient services. REMOTE-Neuro was designed to bridge this translational gap by developing clear, stakeholder-informed recommendations grounded in how care is actually delivered by clinical teams and experienced by patients and carers.

What we did

We used a two-phase mixed-methods approach.

National analysis

We analysed free-text responses from:

• 2,463 patients and carers (Neurological Alliance survey)

• 593 neurologists (Association of British Neurologists surveys)

This provided one of the largest multi-stakeholder datasets on remote care within a single specialty.

Co-production

We then worked with 64 patients, carers and healthcare professionals through workshops, interviews and focus groups to:

• validate findings

• refine interpretation

• co-produce practical recommendations

The final outputs were aligned with the NHS Long Term Plan and the Outpatient Recovery and Transformation Programme.

What did we learn?

Participants valued flexible choice in consultation modality, recognising the accessibility and convenience of remote care, but expressed concerns about clinical quality, privacy and equity. Both patients and clinicians viewed remote care as a distinct skill set requiring tailored training and stronger digital infrastructure.

A particularly important finding was that some patients appeared to perceive remote appointments as less legitimate or lower value than face-to-face care. This has implications for engagement and equity and exploring and addressing this legitimacy gap is likely to be just as vital as any technical upgrade.

What we recommend

We co-produced the REMOTE-Neuro Framework: REcommendations for optimising Modality, Operational efficiency, Training and Equity in NEUROlogy

The framework focuses on practical, implementable changes, including:

• supporting real patient choice of appointment type where clinically appropriate

• using robust triage systems to match patients and problems to the right modality

• recognising remote care as a distinct clinical skill, with training and support for staff

• developing clear, co-produced information to help patients prepare for remote appointments

• ensuring access to private, confidential consultation spaces

• maintaining capacity for timely face-to-face follow-up when needed

• improving booking systems, and digital infrastructure

• protecting time for service development and innovation

• monitoring services for equity, safety, and patient experience

Rather than acting as a rigid checklist, the framework provides a structured, adaptable approach that services can use to implement and evaluate hybrid neurology care in their local context.

What difference could this make?

REMOTE-Neuro provides a practical route from broad policy ambition to real-world implementation.  Rather than serving as a rigid checklist, REMOTE-Neuro is designed to be adapted through local co-design and aligned with available infrastructure. It prioritises what matters most to staff and patients to enable continuous and meaningful quality improvement over time.

It helps services address key questions such as:

• Which patients are best suited to remote or face-to-face care?

• How can safety and quality be maintained within hybrid models?

• What support do patients and staff need to make remote care work well?

• How can services reduce inefficiencies while improving experience?

Although developed in neurology, these challenges are shared across many specialties. The framework therefore has wider translational relevance for outpatient services across the NHS seeking to optimise hybrid care.

What was the impact?

REMOTE-Neuro has already made a contribution to academic, clinical, and policy discussions.

• The study has been published in BMJ Neurology Open as REMOTE-Neuro: Co-produced Recommendations to Optimise Remote Neurology Care 

• Professor Chris Kipps was invited to give a platform presentation on the work at the Association of British Neurologists national conference in Edinburgh

• The Neurological Alliance presented the findings to the NHS England Transformation Team

• The outputs have informed local outpatient transformation discussions at University Hospital Southampton

• The recommendations are contributing to ongoing discussions with the ABN Quality Committee regarding the development of a clinical guideline for remote appointments in neurology

  
  

This demonstrates early impact at both local and national level, and positions the work as a practical contribution to current debates on outpatient redesign.

What’s next?

Next steps include:

• supporting implementation and evaluation of the framework in practice

• developing more detailed neurology subspecialty guidance

• contributing to the development of a clinical guideline for remote appointments in neurology with the ABN Quality Committee

• further research into issues such as patient perceptions of value and equity in hybrid care

More broadly, REMOTE-Neuro provides a strong foundation for ongoing work on inclusive, person-centred outpatient design across neurology and other specialties navigating the optimisation of hybrid care.