AIMS: To examine current practice and views regarding neurological assessment and monitoring across stroke services in the United Kingdom. METHODS: A cross-sectional survey of UK secondary care stroke services was conducted between December 2019 and September 2021. RESULTS: The response rate was 80% (n=125/156 services). Glasgow Coma Scale was the most frequently used routine neurological assessment (96%). Variation in frequency, duration and response to monitoring was evident across all stroke types. Medical escalation was the most frequent response to neurological deterioration (99%). Respondents acknowledged the importance of neurological monitoring, inadequacies of common tools, and supported further work to improve assessments and response protocols. CONCLUSION: The extent of variation in clinical practice of neurological assessment and monitoring across the UK was unknown. Variation was found to be greater than anticipated. There is a need, and desire for, stroke type scenario-specific monitoring and standardised response guidance in acute stoke care. Introducing standardised care in this area would strengthen clinical protocols and could remove unwarranted variation in patient care ultimately improving outcomes. FUNDING: Alison McLoughlin, Doctoral Research Fellow DRF-2018-11-ST2-074 was funded by the National Institute for Health and Care Research (NIHR) for this research. Some of the authors are funded by the NIHR Applied Research Collaboration North West Coast. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.