MS service improvement project at ESHT

Project write up

In order to offer high quality care for people with MS locally, the Neurology Department of East Sussex Healthcare Trust is building a new extended MS service. This development is crucial to delivering all range of NICE approved disease modifying therapies (DMT) as close to home as possible in keeping with NHS England specialised neurology programme of work.

Historically, our MS service was provided in collaboration with the regional Neuroscience Centre. We have over 903 MS patients on our database, including 365 patients under DMT. Our current pathway divides MS patients under DMT into two groups:

1. Patients on first-line treatment like Beta Interferons, Glatiramer Acetate, Teriflunomide, and Dimethyl Fumarate (169 patients) are fully treated under the care of East Sussex Healthcare Trust.
2. Patients on second-line/ more aggressive treatment like Fingolimod, Alemtuzumab, Natalizumab, Cladribine, Ocrelizumab, Ofatumumab and Siponimod (196 patients including 25 patients on Natalizumab) who are under shared care with the regional neuroscience centre. DMT are provided by the neuroscience centre, we however still provide symptomatic management to these patients as per the shared care agreement.

Proposal

With a growing MS population (annual growth of 2.4%) and an increasing number of available MS DMTs combined with capacity restrictions, our regional neuroscience centre is finding it increasingly difficult to accommodate this growing demand. It has opened the discussion about the optimum clinical pathway for patient with MS living in our local area and our Trust is now advancing in its plans to deliver a new MS service close to patients’ home.

1. We have established a specialist MS team with leading neurology consultant, MS specialist nurse lead, together four MS specialist nurses, MS coordinator, pharmacist and neuroradiologist.
2. We started multidisciplinary MS clinics, where we can see timely patients with suspected MS or follow up MS patients who need an urgent review.
3. We are in advanced stage of establishing an agreement with one of London neuroscience centres to establish weekly MS MDT. It is to link virtually with their MS specialists including MSologist, neuroradiologist and neuropharmacist- for supervision, complex case discussion and decision making for highly efficient DMTs.
4. DMTs are going to be offered close to home in cooperation with our local infusion unit-agreement and arrangements are already in place.
5. Blood test and monitoring will be provided close to homer by our MS specialist nurses with administrative support of our MS coordinator.
6. MRI monitoring will be delivered by our radiology department under supervision of our local neuroradiologist and if indicated reviewed by MS MDT with specialist centre.
7. The initiation of DMTs and monitoring will be supervised by our pharmacist.

Plan

Our plan is a significant transformation of our MS service. We are therefore intending to expend our new service in progressive stage, starting with the management of newly diagnosed patients on Natalizumab. We predict should not be more than a handful of patients annually with four weekly infusions for each of them. Our aspiration is however to take over all MS patients living in our local area within the next few months/one year time.

This transformation will benefit our local patients who currently have to travel for treatment on a regular basis as well as relieve the pressure on our regional neuroscience service which has been experiencing difficulties with the ongoing increase in growth.