{
  "abstract": "Objective To examine stakeholder experiences of remote neurology outpatient care and to co-produce an evidence-based framework to support safe, equitable and sustainable service delivery.Methods We undertook an inductive thematic analysis of free-text responses from three national surveys: a patient and carer survey conducted by the Neurological Alliance (2021; n=2463) and two surveys of neurologists conducted by the Association of British Neurologists (2020 and 2021; n=593). Findings were validated through co-production workshops and interviews with patients, carers and healthcare professionals in 2024 (n=43). Themes were triangulated and refined to generate stakeholder-endorsed recommendations.Results 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. Importantly, some participants perceived remote appointments as less legitimate than in-person consultations, a novel and under-recognised challenge with implications for engagement and health equity. Five domains aligned with National Health Service (NHS) transformation principles were identified: (1) patient-centred care, (2) neurology and specialist area considerations, (3) clinical safety and quality, (4) capacity and sustainability and (5) operational efficiency. These findings informed the REcommendations for optimising Modality, Operational efficiency, Training and Equity in NEUROlogy (REMOTE-Neuro) framework.Conclusions Remote care continues to offer significant benefits to both patients and clinicians. However, several years postpandemic, there are still unresolved issues which limit its effective integration with face-to-face care.Practice implications REMOTE-Neuro provides a co-produced set of recommendations to optimise remote neurology practice. Grounded in over 3000 stakeholder perspectives and aligned with NHS transformation priorities, it offers a practical roadmap for implementation in neurology and a transferable model for other specialties.",
  "authors": [
    {
      "affiliations": [
        "University of Southampton, Southampton, UK",
        "National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, Hampshire, UK"
      ],
      "name": "Patricia Fuller"
    },
    {
      "affiliations": [
        "University of Southampton, Southampton, UK",
        "National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, Hampshire, UK"
      ],
      "name": "Sarah Fearn"
    },
    {
      "affiliations": [
        "Patient and Public Involvement Representative, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, Hampshire, UK"
      ],
      "name": "Sally Dace"
    },
    {
      "affiliations": [
        "Patient and Public Involvement Representative, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, Hampshire, UK"
      ],
      "name": "Amanda Wollam"
    },
    {
      "affiliations": [
        "Dementia Research Centre, University College London, London, UK"
      ],
      "name": "Angeliki Zarkali"
    },
    {
      "affiliations": [
        "University of Southampton, Southampton, UK"
      ],
      "name": "Adam Cowan"
    },
    {
      "affiliations": [
        "The Neurological Alliance, London, UK"
      ],
      "name": "Sam Mountney"
    },
    {
      "affiliations": [
        "The Neurological Alliance, London, UK"
      ],
      "name": "Georgina Carr"
    },
    {
      "affiliations": [
        "Department of Clinical and Experimental Epilepsy, National Hospital for Neurology and Neurosurgery and Institute of Neurology, University College London, London, UK",
        "The Association of British Neurologists, London, UK"
      ],
      "name": "Sofia H. Eriksson"
    },
    {
      "affiliations": [
        "University of Southampton, Southampton, UK",
        "University Hospital Southampton NHS Foundation Trust Wessex Neurological Centre, Southampton, UK"
      ],
      "name": "Christopher Kipps"
    }
  ],
  "title": "REMOTE-Neuro: co-produced recommendations to optimise remote neurology",
  "uid": "fbdd92bf-a907-5ddb-a992-8b7e4281f058"
}