Functional neurological disorder (FND) in Primary Care: A Survey of General Practitioners’ Knowledge, Attitudes and Practices

Background Functional neurological disorder (FND) is a common but complex neurological condition that presents an increasing burden in general practice. Recent developments including the inclusion of FND in the NICE guideline NG252 and NHS England's minimum service requirements highlight the need for improved primary care recognition and referral pathways. Aim To explore the knowledge, attitudes, and clinical practice of local primary care practitioners regarding FND. Design and setting: A cross-sectional survey of 34 primary care clinicians across Lancashire and South Cumbria. Method A 16-item online survey incorporating Likert scales, descriptive multiple-choice questions, and free-text responses was disseminated via the integrated care board network. Descriptive statistics were used alongside Spearman’s rank-order correlation to assess associations between training and confidence. Free-text responses were reviewed to identify common themes. Results While most respondents could identify FND, only 8.8% reported confidence in recognising it in primary care, and the same proportion felt adequately trained. Perceived adequacy of training strongly correlated with confidence in recognising (ρ = 0.559) and explaining (ρ = 0.547) FND. Most clinicians reported a rising number of FND presentations, with key challenges including diagnostic uncertainty and limited access to multidisciplinary support. Two-thirds supported dedicated FND services, and over half expressed willingness to undertake further training. Conclusion Primary care clinicians lack sufficient confidence and training to effectively support patients with FND, despite increasing demand. This study highlights the need for structured, primary-care-focused training and service development to improve outcomes for people with FND and to ensure practice aligns with emerging national guidance and standards.