Craniocervical Instability: Health Services

National clinical guidance, including guidance jointly issued by the Royal College of General Practitioners and the Royal College of Psychiatrists, explicitly instructs clinicians not to apply psychological explanations prematurely, and to conduct a full physical assessment before concluding that symptoms are medically unexplained or psychogenic. This principle applies in cases of suspected Ehlers Danlos syndrome (EDS) and craniocervical instability, because premature psychological labelling can delay the identification and subsequent treatment of structural instability.

Integrated care boards are responsible for ensuring that local pathways support timely access to relevant specialists, including neurology, rheumatology, and spinal services. Specialist centres are also expected to use multidisciplinary approaches, drawing on neurology, neurosurgery, pain, and physiotherapy expertise, to ensure accurate diagnosis and to avoid misattribution of symptoms. We continue to work with NHS England to improve consistency of assessment for people with complex, multi‑system conditions, including EDS, and to ensure that patients are referred to appropriate physical health services where clinically indicated.