As part of our innovative GEMSS (Generating Evidence in MS Services) programme, we convened an expert consensus group to develop a view about what is a sustainable caseload for MS specialist nurses. The results are described in our report Modelling Sustainable Caseloads: MS Specialist Nurses.
The consensus group found that for an MS specialist nurse with a mixed caseload, and not in an exceptionally rural area, a caseload of 358 people with MS is sustainable. There are a number of conditions which need to be met for this to be achieved, one of the most important is that every whole time equivalent (WTE) MS nurse should be supported by an administrator/coordinator role. (We recommend 0.6 WTE administrative staff for each full time specialist nurse).
Optimising your capacity
Evaluating the current capacity of your service and how your service uses resources is a useful exercise, and is helpful if you do decide to develop a business case. Taking some time out from the overwhelming pressure of a busy caseload to reflect on how you might work smarter, not harder, can be really valuable. With this in mind, the MS Trust has created a capacity planning tool to help MS nurse teams plan their time and resources more effectively. To access the tool, please email firstname.lastname@example.org.
You can also download a helpful MS specialist nurse capacity planning workshop presentation (PDF 872kb) explaining our capacity planning model and highlighting how teams may consider using existing capacity more effectively.
If you would like help to put together your job plan, capacity and activity data and use it to analyse your current use of capacity, please contact the GEMSS team at email@example.com.
Markers of an effective and efficient MS service
In 2016 we created a checklist summarising the MS Trust’s view of a high quality MS nurse service, based on the work of the GEMSS programme. This highlights a number of important measures of an effective, efficient and sustainable MS service, which you can use to evaluate your own service. The 17 markers are outlined in detail in the checklist and include:
- access to and contact with an MSSN for people with MS
- support for people recently diagnosed with MS
- education and information for people with MS
- service audit
- a sustainable caseload
- sustainable and comprehensive job plans
- administrative support
- up to date data on service activity and caseload.
Download our markers of an effective and efficient MS specialist nurse service checklist (PDF 373kb) .
Writing an effective business case
The MS Trust’s 2016 mapping access to MS nursing across the UK work showed that 64% of people with MS in the UK live in areas where MS nurses have caseloads in excess of the MS Trust sustainable caseload figure. Nearly 25% live in areas where caseloads are more than twice the sustainable level.
If that’s the case for your service, you may want to consider submitting a business case within your organisation for additional staff.
The MS Trust has created a guide to creating a strong business case, providing practical advice on writing an effective and engaging case for your service. You can obtain a copy of the guide, an example business case and additional tailored advice, by contacting the GEMSS team at firstname.lastname@example.org.
Before you start writing a business case, you will find it helpful to know:
(outlined in full in the business case guide)
- the timetable and process for submitting business cases within your organisation – is there a proforma that you have to use?
- the current number of people with MS on your caseload and any information you have about how this is growing
- the current job plans of the nurses in your team – both in terms of how they spend their sessions during the week and how many appointments or home visit slots are planned in each session
- your service activity over the past year – as a minimum, the number of outpatient consultations, home visits and an estimate of phone calls received from patients. If you can’t easily obtain this, you could collect it over a few weeks as a proxy
- any information (if you are in England) you can find out about how your trust generates income from your service, as this varies by area – for example, are your clinic consultations paid for using a national or local tariff or on a block contract? Are telephone consultations reimbursed to your trust? Your business manager, nursing manager or finance manager should be able to help you find this out
- what users of your service think of it now, and where there are unmet needs: our GEMSS patient survey for MS teams service can be a useful starting point to help you develop evidence from service users for your case
- the strengths and weaknesses of your existing service: for instance through a SWOT analysis (strengths, weaknesses, opportunities, threats) to prompt discussion in your team
- the resources you will need to address the issues you have identified: for instance, will recruiting another MS nurse address the specific challenges you face? If so, how exactly? Our MS Forward View report on Improving the Efficiency of DMD Provision explains how, in larger teams, support and therapies nurses can be a cost effective way of expanding capacity
- which stakeholders (neurologists and business managers, for example) will also be involved?
The intended impact of recruiting a new member to the team and how the service will develop as a result. Creating a new job plan, supported by the GEMSS capacity planning tool, will help you work out how a new post will impact existing ways of working.
Writing a strong case study
A case study provides a close up and in-depth look at how a real world situation has unfolded and the range of factors that contribute to this. In the context of MS services, we can use case studies to illustrate the role and impact of the service on people using it. We can also use case studies to explain how an MS Health Professional works with others and undertakes service development in order to better meet the needs of people with MS.
In case studies we are generally seeking to attribute a positive change that has taken place to the work that an MS Health Professional has done and therefore want to describe the circumstances before the intervention, what the Health Professional did and the impact that this had. Case studies can also be used to illustrate the complexity and challenge of a situation in which there was not a positive impact but where important lessons were learned.
Case studies often sit alongside a suite of evidence to demonstrate the value of a service or individual’s actions. They bring data sets or descriptions of processes to life. Case studies may be used as standalone documents, or as part of wider reports or business cases.