The Republic of Ireland has one of the lowest neurologist per population ratio in the developed world, with only 35 consultant neurologists. Despite expansion in numbers, access to a neurology service remains limited, with out-patient waiting lists of 3 years in some hospitals. The burden of in-patient neurological consults is well documented, much of which might be avoided if out-patient access were readily available. From January 2012 to August 2014 data were collected on patients attending a newly appointed neurologist’s out-patient clinics. Fifteen hundred patients were seen. Over forty percent were discharged, either after initial visit or after investigations. The most common diagnoses in order of frequency were headache, seizures, ‘other’ (including syncope), neuropathy and multiple sclerosis. The large proportion of patients requiring follow-up highlights the difficulty in continuing to see new patients as a clinic accumulates patients with chronic neurological conditions. Headache was the most common reason for referral; rarely due to a serious underlying cause in this series. An alternate pathway for patients with headache and consideration of GP access for brain imaging in selected circumstances would have a significant impact on general neurology waiting lists and access to a neurologist.