Discover how you can make MS care more efficient, effective and equitable for people with MS.
Based on the care and service priorities identified in our MS Forward View consensus statements, these practical steps can be used to enable MS services to deliver fair care to everyone living with MS.
We hope that teams will be able to implement these ‘quick wins’ (or, at least, some of them) relatively easily.
Some of them are a way to get started and will help you lay the foundation for a more detailed piece of work; others will achieve an end in themselves: all of them will help us move to towards delivering more effective, efficient and equitable care for people with MS.
If every MS team implements one or more of these we can all make a big difference to services for people with MS.
Working with other services to ensure seamless, coordinated care
|Map local services for people with MS and promote joined up working||Make a list of all the health and social care professionals you work with and refer people with MS to. This will help you start to see where the gaps are, where links with other services could be improved and where there is already the basis for developing stronger, more formal links. Think about which of these services are particularly relevant for people with advanced MS and how you could share this information with people who might need them. Arrange to meet with some of the key professionals you identify to talk about how you can work more closely together to provide better coordinated care|
|Connect with a local neurorehabilitation consultant||Meet with the neurorehabilitation physician and discuss when you should refer people with MS to them and what they can offer and how you can work together to ensure your services are better coordinated|
|Create a leaflet about your service for other professionals||Develop a leaflet/web page about your service and distribute this to other health professionals and people with MS. Consider sending to GP surgeries in your area so that they can refer people with MS back into your service when they see them|
|Communicate with GPs about DMDs||Implement a system which ensures that the MS nurse or the neurologist write to the GP before someone starts treatment with a DMD and think about the information you want to communicate. As a minimum the GP needs to know which DMD is being taken, when they are due to start; key things to watch for (eg. lymphopenia) and who in the MS team they should contact if they have any questions|
Ensuring everyone with MS has a comprehensive annual review
|Audit your service||
Run an audit on an aspect of your service to give you baseline data. For example:
Care planning – how many care plans do you (and your colleagues) write in a month – do the people that you write those care plans with know that they have a care plan? Do they feel the care plan addresses all their goals?
Annual reviews – how many of the people you see are receiving annual reviews?You can also use our patient survey for MS teams service to run a more general audit of your service
|Provide home visits||Are you able to provide home visits? If not, consider making the case to your manager for allowing this, and talk to colleagues in other teams who do provide this facility about how they justify this with their manager/commissioners. If you are already providing home visits make sure that you have a robust home visit policy in place to ensure they are used effectively|
Care for people with advanced MS
|Lead for advanced MS||Decide who will be the lead for advanced MS in your team and let other health professionals know who you are. Look at your caseload and start to think about who you would class as having 'advanced MS' and how many people there are in this category – does this match with local prevalence estimates? Think about how you can start to bring people with advanced MS back in to the service if they haven’t been seen for a long time|
|Connect with a local palliative care team||Speak to your local palliative care team about: what they can offer people with MS; how you can refer people into their service; whether they run any training which might be useful for you or your colleagues and whether they would value any training from you|
Making the most of the clinical expertise of MS specialists
|Write a case for a DMD coordinator role||Put together a business case for a DMD coordinator/administrator role to improve the efficiency of your DMD service and free up specialist nurses’ capacity. We can help with this – see our advice on writing a business case, or give us a call|
|Appointments for people on DMDs||Consider the format of your MS nurse appointments for people on DMDs. Is there someone else (such as a support nurse or healthcare assistant) who could conduct blood tests and monitoring, so that people with MS are able to focus on their other needs and benefit from your specialist advice when they see the MS nurse?|
Making DMD monitoring safer, more efficient and more convenient
|Order MRIs||Would it make your service more efficient if MS nurses could request routine MRIs (eg when referring someone to DMD clinic for review or prior to annual review with neurologist)?|
|Non-medical prescribing||Are you a qualified prescriber? Consider talking to colleagues who are, and think about how you could improve care for your patients if you were able to prescribe. Think about what extra help/training/support you would need to feel confident about prescribing and who could help you get that|
|Involve pharmacists in your DMD service||Is the hospital pharmacist involved in your DMD service? Consider speaking to them about what they could offer – they might be able to help with things like Home Care and some can even help with checking blood monitoring etc. Our report, Improving the Efficiency of DMD Provision, covers this in detail|
|Group discussions about DMDs||Consider using a group discussion format for people who are starting on the same DMD in a similar time frame. This could be an opportunity for group education (see model above) about a particular DMD and its associated side effects and monitoring etc. You might also consider setting up an online forum (such as a private Facebook group) for this group to continue their own discussions for peer support|
|Keep track of blood monitoring for DMDs||Do you have an effective system to help you keep track of the blood monitoring for people you see on DMDs? If not, perhaps take a look at some of the options available. Talk to the drug companies and to colleagues around the country who are using different systems and discuss with your neurologist about what system you might implement and how|
Reducing variation in access to and use of DMDs
|Work with other centres to provide the full range of DMDs||Can people with MS access the full range of DMDs in your area? If not, talk to your neurologist about how you might potentially work with other centres to expand the range of DMDs you can offer|
Sharing knowledge with other MS health professionals
|Plan self-management courses with other local professionals||Think about how you can facilitate more self-management with people with MS on your caseload. Can you work with other nurses/AHPs in your local area to run fatigue management courses, bladder workshops, DMD discussion groups etc.?|
|Share examples of innovative practice||There are lots of examples of innovative practice around the UK – share ideas, learn from each other, use your local and professional networks and use the MS Trust to find out what others are doing and tell us if you think you have a good idea/solution. Our collection of case studies of innovative practice in MS services is a good place to start|
Organise a ‘training exchange’ with other local professionals
|Consider setting up a training exchange with other health and social care teams in your locality. Could you offer training to different teams? In return they may be able to provide your team with updates/training too|
Useful links and publications
'Trojan mice' - NHS Alliance: the introduction of a small change in practice which leads to a large and lasting positive change in the life of a person or a community, with a useful two-minute animation
MS Trust: Developing relapse services
MS Trust: GEMSS patient survey for MS teams
MS Trust: GEMSS programme 2012-15
MS Forward View: Funding and NHS MS Services in England
MS Forward View: Improving Services for People With Advanced MS
MS Forward View: Improving the Efficiency of DMD provision