Welcome to Commissioning for MS

Who can use the pathway?

Commissioners of services for people with MS can use it to map out the complex services needed for people with MS and identify what needs to be commissioned to provide a good service.

Health and Social care professionals can use it to describe services to others, to map out the services they need to provide and to identify what a good service should look like.

People with MS can use it to compare their own experience against the pathway, and to identify what a good service should look like.

What is it for?

The pathway sets out the “journey” of living with MS. It is not a medical flowchart like the Map of Medicine.

It starts before someone is diagnosed and moves through the various stages and experiences of living with MS.

It sets out the needs of people living with MS and those of their families. Not just the medical needs, but social and rehabilitation needs.

It recommends the actions, or treatments, that will help people to manage MS successfully. It provides additional information and links to other resources such as NICE Clinical Guideline 8 and the National Service Framework for Long Term Conditions. These give further guidance and are regularly updated.

What do all the sections mean?

This is how you will see the pathway on your computer screen.

The pathway is not a linear design but one that reflects the variability and unpredictability of MS. It demonstrates how the person with MS may need rapid access to specialist services.

The pathway is designed to move horizontally along the tiers or vertically through the columns.

Each box contains information about what should happen at a particular stage and some boxes also have additional or supplementary information that can be made visible using the mouse. This is explained later on.

Some boxes have links to other websites for more information. This is explained later on.

The Tiers

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  The Tiers 1

  The first tier of white oval shapes sets out the assessment and history required for investigation into a new diagnosis, when there is any change in someone's MS or if they need highly specialist support.

  It describes what is required at the first assessment, and this may be at the GP surgery or with an MS Specialist nurse if the diagnosis is established.

  It describes what is required if the assessment is with the specialist team or if there are complex needs.

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  The Tiers 2

  The second tier of blue rectangles sets out the diagnostics that are needed for diagnosis, for starting treatment and when there is any change in someone’s’ MS.

  Each box describes what diagnostic procedures may be required for investigation into a number of different problems. The GP, the Neurologist or an MS Specialist nurse may request them.

  It guides on what and where diagnostic tests should be considered and performed and treatment thresholds following investigation.

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  The Tiers 3

  The third tier of green rectangles sets out the definitive treatments that can be considered for different needs and at different times.

  Definitive treatments will include medical treatments such as disease modifying therapies and symptom management.

  Definitive treatments are not just medical treatments and will include such things as fatigue management; self care information and newly diagnosed groups.

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  The Tiers 4

  The fourth tier is the most important as it underpins the whole pathway. This tier sets out the rehabilitation and review needs of people with MS.

  It includes the wider needs such as remaining in work, family support, advice about finances and the rights of people with MS.

  It includes the measurement tools available to assess outcomes for people with MS and how to monitor effectively through change and transition in MS.

The Columns

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  Column 01

  This column tells us about

  • Symptoms experienced before and after diagnosis
  • Incidence/prevalence of MS
  • Self care and assessment
  • Importance of preventing secondary complications
  • Hyperlinks are to patient information

  This column show us the escalation thresholds that prompt someone to seek advice and the red flags that move the patient, or another, to seek advice from primary care.

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  Column 02

  This column tells us about

  • Assessment needs in Primary care
  • Diagnostics in Primary Care
  • Treatments in Primary Care
  • Rehabilitation and review in primary Care
  • There are hyperlinks to GP guidelines

  This column is about patients who are undergoing pre diagnosis investigation or post diagnosis episodes and need the following:

  • Treatment for further relapsing episode or symptom management
  • Post diagnosis and/or ongoing support
  • Rehabilitation and review
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  Column 03

  This column tells us about

  • Specialist assessment
  • Specialist Diagnostics
  • Definitive treatments
  • Rehabilitation and review
  • There are Hyperlinks for National clinical guidelines

  This column is about those who need to have the diagnosis of MS confirmed or who have confirmed MS and require further specialist input. This may be for

  • Monitoring
  • Assessment and review
  • Changes in treatment
  • Rehabilitation
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  Column 04

  This column tells us about

  • Complex treatment options
  • Complex rehabilitation
  • Palliative and end of life care needs
  • There are hyperlinks for palliative and end of life care needs

  This column sets out MS specialist services as an in reach and out reach service emphasising that the services they provide must be patient centred and relevant to their needs at any stage of the condition.

  The guidance and advice from supra specialist services should enable care and support to be given as close to home as possible.

How do I use the pathway?

The pathway is a “living” tool and can help to identify the services that really matter to people with MS and put them in the right place. Using the mouse will enable the user to get the best from the pathway.

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  By moving the mouse over the screen you will highlight any additional information. When you scroll over the text boxes some will have this grey text box appear. (Click boxes on the left to expand)

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  This means there is further supplementary information (SI). The SI will not be visible on the global screen and will require you to open the menu in the top left hand corner.

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  By clicking on the supp. info menu you will access more information that is also downloadable.

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  This will provide more information and links that will help in delivering the right care and support to people with MS.

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  Some points on the pathway will have this symbol. This indicates a hyperlink to another website with information relevant to that part of the patient pathway. This maybe a clinical guideline or a national policy and is regularly reviewed to make sure all the information is current and still relevant to MS services.

  By clicking with the mouse on this symbol you can go straight to the website and the information required for that part of the pathway.

  Some of the information is useful to health and social care professionals and some is useful to people with MS and their families. Go to the walk through presentation here and the live pathway here.

Can I tailor it to my local requirements?

The pathway can map out the likely numbers of people with MS in the locality, what services are already available in their area and what services may need to be commissioned.

It will identify what is missing in local services for people with MS.

The pathway can be localised and local information inserted at any point along the pathway.

You can create up to ten pathway layers to describe the core clinical processes to be commissioned, patient information on services available, workforce requirements, technology aids, commissioning levers and other information that is bespoke to your requirements.

Local information and resources can be mapped along the pathway and new solutions identified to meet the needs of people with MS.

To find out more about localising the pathway click here or visit www.pathwaysforhealth.org.

How do I use it with my team, my commissioners or the local service user group?

The team can use the pathway to map out their roles and responsibilities and identify the gaps in skills, resources and innovation required to maintain a good MS service.

The pathway can be used by health and social care professionals (providers) to engage in discussion with commissioners (purchasers) on current service provision and how it matches against the pathway.

It will identify the skills and resources needed to deliver a good service in a format that is understandable to a range of people.

Local service user groups can use the pathway as a tool to identify their needs and negotiate with providers on what should be provided locally.

It can inform people with MS of potential support and treatments and where, when, and by whom, they are likely to be initiated.

The pathway can navigate people with MS to information that is appropriate to their current circumstance, and help avoid exposure to irrelevant or inappropriate information.

The pathway offers evidence based effective care and support that is timely and holistic. It sets out what matters most to people with MS not what matters most to the organisational structure or professional discipline.