Analysis of Community Caseload and how to Manage Duplication of Services

By Sarah Roderick, MS Nurse Specialist, Cambridgeshire and Peterborough NHS Foundation Trust


This project was awarded runner-up .

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Project write up

This poster illustrates the start of a long process to make changes within the system with the goal of reducing duplication of patient contacts, improving communication across different NHS Trusts and ultimately, saving money for the local Commissioning Care Group.

The aim was to start to analyse information about a community caseload held by MS Specialist Nurses in a Nurse-led service. This service sits within a Community Neuro Rehab Team and has 294 patients. Patients are seen from diagnosis to end of life. Patients on DMTs are also seen by MS Nurses and Neurologists in a local Neurological Hub. Patients with progressive MS may also be seen by a Neuro Consultant or a Consultant with a special interest in clinical trials for progressive MS if a referral is made. There are many occasions when patients may be seen by multiple teams, possibly in the same week or even day.

This author aimed to look analyse the caseload and try to identify how duplication of services could be reduced. As an added piece of work, the author would like the MS Nurse assessments to be visible for other teams, rather than the patient having to repeat the whole history, thus complimenting each patient contact. By working with the other teams and making changes, this has been possible.

Although this is primary analysis, looking specifically at patients within the one caseload. The data does show that some groups of patients have multiple appointments in a year, and others get very few. This is something that needs to be looked at strategically to ensure an equal service to all patients with MS within the wider county.

Some changes have already been implemented since starting this work, such as assessments being better shared and accessed between trusts. The next step will be to work across boundaries and find a way to reduce duplication and streamline services.

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