How many MS specialist nurses do we need a caseload survey?
Alison Leary, Healthcare Analyst, London
Way Ahead 2012;16(2):5
In March 2012, the MS Trust published a report, Defining the value of MS specialist nurses1. This important study summarises the evidence for specialist nursing, in MS and other specialties, and points to further work which would enable MS specialist nurses to prove their worth and make a case for maintaining and improving services.
Following on from this, a new piece of work funded by the MS Trust looking at the number of patients per MS specialist nurse is now underway. We already know that there is a lot of variation in MS specialist nurse caseload as this has been demonstrated in a recent National Audit Office Report2. The audit noted that the number of people with MS per MS specialist nurse ranged from 220 in the East of England to 650 in the North West.
Based on the MS Trust map of services in the UK www.mstrust.org.uk/map, there are estimated to be 220 MS specialist nurses across the country. Although this has grown from just three in the 1990s, it is estimated that there is still a significant shortfall. With approximately 100,000 people living with MS in the UK, this means that many of the existing MS specialist nurses have high caseloads and there are reported gaps in services provided.
The work of MS specialist nurses is very complex, involving various roles and a high degree of knowledge and expertise. Different areas of the country require different services and this can make it challenging to calculate an absolute number for an MS specialist nurse caseload. There are many variables to take into account, including how many other professionals, such as physiotherapists and social workers, are available or how the MS specialist nurse manages his/her practice (some need to do more home visits which are more time consuming). Many services have evolved over time perhaps with only one MS nurse and a neurologist.
As there are so many variables to consider, MS specialist nurses are being interviewed for the survey and data collected on the services they offer and any gaps they feel they would like to meet given the needs of the people they serve. In addition, some MS specialist nurses carry very high caseloads so that patients remain on their list and do not have to go through the added burden of rereferral - this is one of the things that frustrate patients and carers according to the National Audit Office report. Different people will need different levels of input from their MS specialist nurse at different times and it is important to factor this into the calculation. One way of doing this, is to look at the input of the nurse across the MS patient journey.
To try and determine the optimum caseload for the MS specialist nurse, a number of interviews have been undertaken and data collected on different types of services across England, Scotland and Northern Ireland. Data has been collected on how many clinics, home visits and out reach services the nurse provides. The survey has also looked at workload, such as numbers of phone calls made, as almost one third1 of an MS specialist nurse's time is spent on the phone offering clinical advice, making referrals or helping other health professionals, such as GPs, with expert advice. The information collected is being used to build a model of the work of the MS specialist nurse and his/her caseload. From this, and perceived gaps in service, it will be possible to examine how many extra nurses or other professionals are needed to make up any shortfall. As part of the nurse support programme, the MS Trust will campaign to ensure people with MS have the right access to specialist support.
All of this information will be compared with other studies in people with MS which have identified gaps in services, NICE guidance and the recent MS Trust commissioning pathway. This will allow us to determine the optimum caseload range for the MS specialist nurse working in different environments. In addition, it is hoped it will help managers and commissioners further understand the contribution that the MS specialist nurse makes.
- 1. Mynors G, Perman S, Morse M. Defining the value of the MS specialist nurses. Letchworth: MS Trust: 2012.
- 2. National Audit Office. Services for people with neurological conditions: Department of Health. Norwich: The Stationery Office; 2011.