LVN offers an alternative to the existing options of full referral to a tertiary centre and in-house peripatetic services. It is a diplomate-led neurology referral service designed to support primary care vets in the assessment and management of patients with neurological disease within in collaboration with the London clinical community. It provides access to the input of an experienced neurologist through a staged pathway that prioritises clear communication, transparency, continuity and accountability.
When LVN May be Helpful
London Veterinary Neurology (LVN) is intended to fill the gap between tertiary referral hospitals and in-house peripatetic services rather than to replace either pathway.
The LVN model incorporates the traditional values of community-based veterinary practice, continuity of care and close professional relationships into the referral process. It provides clients direct access to a known, experienced neurologist who remains responsible for their care throughout the diagnostic and treatment process and it encourages collaboration and staged decision-making. Accountability and clinical audit are integral to this approach.
Examples of when LVN is helpful:
When it is uncertain whether the condition is neurological and experienced assessment is required.
When the progression and severity of clinical signs is compatible with a staged approach to diagnosis and treatment.
When conservative or medical management is a realistic outcome and the main requirement is diagnostic clarity and guidance.
When the case or client requires a prolonged period of care and clinician continuity and accountability are essential.
The LVN Referral Process
It is recommended that all referrals begin with a consultation. The purpose of the consultation is to determine whether the presenting problem is neurological, define the most likely differential diagnoses and decide whether further investigation or empirical treatment is the most appropriate next step.
When further investigation is indicated, London Veterinary Neurology (LVN) may request blood tests from the referring practice, arrange outpatient imaging or cerebrospinal fluid collection at one of its partner hospitals or recommend referral to a tertiary centre if MRI is required.*
Treatment is provided once a diagnosis has been made. This may be in the form of a written prescription, supervised hospitalisation or surgical treatment at a partner hospital.
All follow-up remains with LVN, with continuity of care and oversight by the same neurologist throughout.
This process allows many patients to be managed locally. Decisions are made collaboratively with the client and in close communication with the referring practice. Written summaries will be provided after each stage of the process.
Patients requiring urgent out-of-hours treatment for suspected intervertebral disc disease should be referred to Veterinary Emergency Spinal Care.
*LVN cannot currently provide access to MRI directly. If MRI is required, this will be discussed openly with the client and the referring practice and referral to a tertiary centre will be recommended. The patient may return to LVN if the client wishes to remain under the continuous care of the same neurologist.
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It is recommended that referring vets estimate only for the cost of the specific service being requested. This is most commonly an initial consultation.
Further investigations or treatments are not assumed in advance. Any additional costs are discussed directly with the client at the point of care, once the initial assessment has been completed and the options for escalation are clear. London Veterinary Neurology aims to help clients understand costs in a staged and transparent way rather than requiring early commitment to a fixed-price estimate.
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Clients seen by London Veterinary Neurology (LVN) remain clients of their referring practice throughout the process.
LVN partner practices provide facilities and nursing support where required, but they do not assume primary responsibility for the case. Clinical decision-making, follow-up and communication remain with LVN and care is delivered in collaboration with the referring vet.
LVN does not provide first-opinion services and does not seek to establish an ongoing primary-care relationship with referred clients. Once the LVN episode of care is complete, patients are returned to the referring practice for ongoing management unless further referral input is required or requested.
This structure is intended to protect the referring practice–client relationship, maintain continuity and ensure clarity about roles and responsibilities at all times.
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London Veterinary Neurology (LVN) is not intended to replace all referral pathways and may not be the most appropriate option in every situation.
In particular, alternative referral pathways are likely to be more suitable for:
Patients in an unstable clinical condition requiring immediate critical care prior to referral.
Patients with acute head trauma or suspected vertebral fracture or subluxation.
Patients requiring multi-disciplinary care at the point of referral.
In these situations, referral to a multi-disciplinary tertiary referral centre with on-site critical care support may be more appropriate.
LVN is always happy to discuss a case and advise on the most suitable referral pathway if there is uncertainty.
How to Refer
Referrals to London Veterinary Neurology (LVN) may be made by primary care vets or by clients directly*.
Referrals can be made by email or via the online referral form.
A brief summary of the case and the reason for referral is sufficient. A formal referral letter is welcome but not required.
If you are a vet who would like to discuss a patient prior to referral, please feel free to call 020 7723 2068. Please note that LVN is unable to provide informal advice to clients who are not already under its care. Clinical advice to clients is provided only within the context of a consultation or ongoing treatment.
*Clients may contact LVN directly to request a consultation. LVN is comfortable providing second opinions and will contact the patient’s primary veterinary practice to obtain relevant clinical history in this context. John will discuss the case prior to the first appointment with the veterinary surgeon wherever possible and share subsequent advice openly to ensure that care remains coordinated.