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A new approach to diagnosing and treating Functional Neurological Disorder (FND) is transforming patient care and outcomes, with a pioneering partnership leading the charge to redefine traditional pathways.



The service is set to replace the traditional Immediate Needs Assessment with a joint diagnostic and rehabilitation assessment from Proclaim Care and Brain & Mind’s expert teams. Reports are completed within 42 days. The FND Service – for patients aged 16 and over – has been created in response to the growing need for new approaches to supporting people with the condition, with the condition becoming more widely acknowledged and understood.

Evidence suggests that with timely, effective treatment, two thirds of people with FND will make significant improvement – but NHS waiting lists are currently around 12 months for the initial specialist assessment, with a similar waiting time expected again before specialist treatment can be accessed.

Clients of the service – which has been created in consultation with insurers, claimant and defendant solicitors – benefit from the significant clinical expertise of Proclaim Care’s Case Manager Flora McMullon, who also has 25 years’ experience of neurological nursing, Consultant Neuropsychiatrist Dr Michael Dilley and Consultant Neurologist Professor Mark Edwards founders of Brain & Mind.

As an established name in case management, Proclaim Care has supported clients with FND for many years, and its belief that something needed to change in this area was echoed by Brain & Mind. The outcome is a unique service which brings together neurology, neuropsychiatry and specialist neurological and psychological therapies into holistic,
client-focused care.

“It’s one of our passions to really drive forward the way in which we deliver case management services, and through this partnership with Brain & Mind we can really change the way in which we’re working across the industry,” says Neil Irwin, Commercial Director of Proclaim Group.

“The pathway we have created is a new and different way to achieve better outcomes for our clients. We are always trying to find ways to do things differently and to improve the industry through education – and we believe, working with Brain & Mind, this is going to be a really important addition for people with FND.”


While FND is not a new condition, the profile it now has is more of a recent occurrence. Through greater understanding of FND, driven by the work of Professor Jon Stone, Professor Alan Carson and Professor Mark Edwards amongst others, more is known about the condition and its impact.

But with this greater awareness has come the risk that FND is now regarded as a ‘catch all’ term for a number of conditions. This can lead to patients being referred from service to service, trying to find the best match for the symptoms they experience, leading to what can be significant decline. Often, they can be directed down a brain injury pathway, which can have a detrimental effect.

“We have often seen people who have actually been made worse through conventional neuro-rehabilitation, because it has been conducted with the belief that their symptoms are all due to a traumatic brain injury,” says Professor Edwards.

“They will have had two years of rehabilitation, where the idea of brain injury has been perpetuated and that this is irreversible structural damage, whereas FND is a change in the way your brain is working, it’s not about damage or degeneration.”

And for those referred between services, and particularly against the background of a legal claim, this too exacerbates their problems.

“In the context of a claim, you have the accident in the background, which might be the cause of this problem, or may have made it worse. You’re being bounced around treatment services, and you can see why some of these symptoms become intractable. And the longer they continue, the harder they are to manage,” says Dr Dilley.

“The accepted dogma within the medico-legal profession that you can’t treat people once they’re engaged in a claim, actually, that’s not true for the majority – I’d suggest the sooner you get to sort them out, the sooner you’ll get to sort out the claim.”

From Flora’s background in nursing, as well more recently in her role as a case manager, she sees first-hand the disillusionment of patients who live with FND.

“From working in acute hospitals and looking after people who have not been given a diagnosis or else have had a really poorly explained diagnosis, I have seen them becoming more disabled because their condition is not being acknowledged, explained and managed properly,” she says.

“It’s a similar story in the community for people who have never really been given a diagnosis, who often develop progressively worsening disability and quality of life.

“Coming into rehab management, I’m passionate about getting an early diagnosis for people as there is the opportunity for some really positive gains.”

While NHS waiting lists are hugely challenging – efforts are being made to improve NHS services and clinical pathways to make them more appropriate for patients, in light of new understanding. However, while undoubtedly positive in theory, in practice, there is a long way to go.

“A lot of the efforts to develop more effective services have been held back by fragmentation…we see that particularly between physical and mental health, and also between specialised and community-based treatment.” says Professor Edwards. 

When an initial enquiry is received, there is a clinical discussion with the individual insurers and solicitors to confirm the referral triggers for the service and agree a collaborative approach.

This is a review of the medical evidence prior to any decision being made to proceed to Stage 3. This aspect of the service has proven to be very effective in the cases received since the launch. It is initially completed by one of the Proclaim Care Case Managers and then shared with Brain and Mind as appropriate regarding the clinical recommended next steps.

The important aspect of this medical review is to ensure that clients clinical needs/diagnosis history is reviewed so that funders are advised on the recommended route for their individual client. A medical records summary report with clinical recommendations for the next stage is issued with guidance on the benefit of entering Stage 3 or whether a traditional INA is recommended.

Stage 3 is the joint rehabilitation and diagnostic assessment from Proclaim Care and Brain & Mind’s expert teams. This is completed face to face with the Rehabilitation Manager and face to face or virtual with Brain and Mind (joint neurology and neuropsychiatry consultant review) within a maximum of 42 day from instruction and a joint report issued.  

As there was no template for this type of reporting, Flora and her Clinical Manager Cheryl Courtney designed a single template that reported on the clinical assessments by both Proclaim Care and Brain and Mind and provided a diagnosis formulation and prognosis, opinion of rehabilitation readiness and clinical recommendations for case management and rehabilitation. 

The benefits of this approach are clear. It ensures correct treatment pathway allocation; prevents inappropriate/costly treatments; minimises condition exacerbation and client disengagement.

There is a range of specialist FND rehabilitation treatment programs spanning local community, day-patient and in-patient settings that may be recommended, but as well as selecting the right kind of treatment, the person needs to be ready for the programme.

Therefore rehabilitation readiness is an important component of this pathway: we assess the client’s readiness to actually engage before it is funded. Establishing readiness can be an important component in building trust with the client, who may have already been rejected by several different services. 

Flora McMullon: 
“They need to trust us; they need to know they are believed. While they could be a candidate for this pathway, it could be that there are other factors in their life that mean this can’t happen right now, be it family, housing, finances, whatever it might be. If they are given the opportunity for the best type of rehabilitation, you want them to be in the best place for that to be successful and for them to make meaningful change.”

Professor Edwards:
“There is good evidence that the longer people go without receiving treatment, the worse their final outcome. The evidence suggests around two thirds of people will see significant improvement with treatment.”

“Through this pathway we plan to gather evidence to see what progress can be made, what expectations can we have, and what improvements can we make to how we work. We hope that can help to inform future approaches to FND,” continues Prof Edwards.

These improvements in service users lives have been captured eloquently in an award-winning nomination for Flora for the FND Hope charity:  

“In September of 2022 I had an accident at work. This pretty much changed every aspect of my life and left me not having a clue who I am or where I am at. I lost vision in one eye and hearing mostly also on one side as well as a weakened left side and cognitive issues. 

After six months of struggling a doctor recommended that I contact a solicitor as private help would be better as the NHS waiting lists were so long it would take a lifetime to get anywhere. I went through one rehab team who was just going through the motions and I felt I had zero help and life was just the same. 

My solicitor changed to Proclaim Care and I was visited by Flora McMullon and a co-worker. Over the coming months Flora arranged a team of people to help me. The neurologist diagnosed FND which I had never heard of or knew anything about. The support and care I received from Flora was literally life changing. She arranged a neuropsychologist and a neurophysio plus OT. 

It was not an easy journey for me and accepting the fact FND is a part of my life was also a journey which continues to this day with changing symptoms and different types of flare ups.Although healing and learning to live with FND is still an ongoing process I would highly recommend Flora for the FND Hope award. She listens which is so important and the whole team is the same. Flora has and does continue to support me and I feel recognition for her is a great way forward for others in the same position as me. 

FND is a horrible condition with many causes. Mine was trauma from an accident which has changed my life but I feel supported and heard and that is the most important thing for me going forwards.”

“There is good evidence that the longer people go without receiving treatment, the worse their final outcome. The evidence suggests around two thirds of people will see significant improvement with treatment.” says Professor Edwards. 

With the FND Service now open for referrals, as well as delivering potentially life-changing outcomes for people who have previously struggled to secure the support they need, it also hopes to demonstrate the importance of earlier intervention. 

It also hopes to deliver on Proclaim Care’s ambition to lead change and education within case management, showing how things can be done differently to the traditional, longstanding approaches to rehab.