REMOTE-Neuro: Co-produced Recommendations to Optimise Remote Neurology

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 = 2,463) 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 = 64). 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 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 REMOTE-Neuro Framework (REcommendations for optimising Modality, Operational efficiency, Training and Equity in NEUROlogy). Conclusions Remote care continues to offer significant benefits to both patients and clinicians. However, five years post-pandemic, there are still unresolved issues which limit its effective integration with face-to-face (F2F) care. Practice implications REMOTE-Neuro provides the first co-produced set of recommendations to support safe, inclusive and sustainable remote neurology practice. Grounded in over 3,000 stakeholder perspectives and aligned with NHS transformation priorities, it offers a practical roadmap for implementation in neurology and a transferable model for other specialties.