National Assembly for Wales

In November 2022 we published the Neurological Conditions Quality Statement.  This sets out Welsh Government’s vision for good quality services for people of all ages living with neurological conditions in Wales, including the outcomes and standards we expect NHS organisations to achieve in delivering services for people with these conditions. This was co-produced with the Neurological Conditions Implementation Group (NCIG) and the twenty plus third sector partners represented in the NCIG by the Wales Neurological Alliance, this includes representatives from The Migraine Trust. The NCIG was funded directly by Welsh Government between 2017-2023, and I expect all NHS organisations in Wales to use the Quality Statement as the basis for planning how services for people with neurological conditions are developed and delivered, including those experiencing headache disorders such as migraine.

Headache disorders are debilitating, and I recognise that timely access to diagnosis has been an issue for people experiencing them.  The All-Wales Headache Toolkit, launched in 2023, is aimed at GPs, Advanced Nurse Practitioners and Physician Associates in Primary Care, and doctors in Accident and Emergency Departments and Acute Assessment Units.   The toolkit provides a quick reference guide for these healthcare professionals and is fully aligned to NICE Clinical Guidelines and supports:

• The implementation of an All-Wales approach to improve headache diagnosis and the differentiation between different headache disorders (migraine, cluster headache, tension headache) and their management.
• Improving awareness and education of clinicians to manage people living with headache disorders.
• Clinicians to empower patients and improve their ability to self-manage their headaches, and understand the goals of available treatments, which in relation to migraine, might not be to eliminate them completely.

The toolkit is intended to provide a reassuring, structured approach to assessing, diagnosing and managing headache disorders in the community, and increase confidence to make a referral where indicated. The NCIG recognised the need for this toolkit and developed it in partnership with the Bevan Commission Planned Care Innovation Programme and The Institute of Clinical Science and Technology (ICST). 

NHS organisations will be supported to implement the Quality Statement by the NHS Wales Executive (the Executive). This is the body responsible for driving improvements in the quality and safety of care.  The Executive will do this in collaboration with a range of National Clinical Leads, and a suite of Strategic Clinical and Implementation Networks all of which will develop work plans setting out their priorities. Since being established in April 2023, the Executive has been phasing in a series of networks and I expect the new Neurological Conditions Strategic Clinical Network (NCSN) to be established very soon, alongside the appointment of a new National Clinical Lead for Neurological Conditions. These are critical building blocks to support the implementation of the Neurological Conditions Quality Statement.

I expect the work plan for the NCSN to take into account workforce requirements and challenges, and to reflect relevant work initiated within the NCIG, including developments such as the All-Wales Headache Toolkit.   I also expect the work plan to detail monitoring arrangements relating to the implementation and usage of any tools or resources developed.  Any workstreams or other activity to underpin the implementation of the Quality Statement will be determined by the priorities identified within the work plan. With regard to the All-Wales Headache Toolkit, implementation has been underpinned by implementation science to maximise uptake and is on track, in line with programme schedule agreed by the partners referred to above. 

From a pharmacy perspective, all medicines that have been recommended by NICE or the All-Wales Medicines Strategy Group (AWMSG) are routinely available in Wales where clinically appropriate.  This includes several medicines people can access through prescribing specialists that have been available in Wales through the New Treatment Fund since 2020 for the prevention and treatment of migraine.   Community pharmacists are able to discuss symptoms and offer a range of over-the-counter treatments for migraine including medicines which were previously only available with a prescription.  Pharmacists can also help people identify factors which may trigger people’s migraines and make lifestyle changes which may help reduce the frequency with which migraines occur.

Approximately 1 in 4 community pharmacies in Wales are now participating in our national pharmacist prescribing service.  From April this year, changes to the service will allow pharmacist prescribers working in those pharmacies to prescribe medication for people presenting with migraine if it is within their scope of practice.  In accordance with NICE guidelines, pharmacists will refer patients experiencing symptoms for the first time to their GP for follow up within eight weeks.   

Neither I, nor my officials, are aware of a new patient self-management App designed to support people living with headache disorders in the community, so I am unable to comment on this at this time, but I would be happy to do so if you could provide further information.