Historically, epilepsy care has been documented as poor. The New Contract introduced epilepsy as a quality indicator from April 2004.

To measure the unmet clinical needs in patients with epilepsy, following an audit, with educational intervention and the introduction of the New Contract.

Prospective audit.

Thirteen general practices (population 68 240).

The case notes of 388 patients receiving treatment for epilepsy were reviewed in the two years before, and four years after, the introduction of the New Contract in April 2004. An intervention took place, which consisted of (a) a letter to each practice summarising the main findings; (b) the provision of a comprehensive template; (c) an individualised categorisation for each patient; (d) a single educational session led by a Neurologist with an interest in epilepsy in March 2004; and (e) the introduction of the New Contract in April 2004.

The audit was completed in 267 cases. There was a significant increase in the annual review rate and documentation of seizure frequency. This happened after the New Contract was introduced, and has been sustained. The number of patients under shared care fell significantly from 22% to 16%. Thirty of the 62 (48%) patients with poor control were not receiving shared care. There were 13 referrals and 32 practice interventions related to the audit, with 39 positive outcomes. There was one death in a poorly controlled patient who was not under shared care, nor had been seen regularly by their general practitioner.

The unmet needs of some patients were highlighted by the audit resulting in appropriate management of these patients. However, despite the significantly improved review rates in primary care, and the availability of specialist services locally, we remain concerned about the proportion of patients with refractory epilepsy who do not seem to be receiving coordinated shared care.