Restructuring of the MS service for HRCH March 2019

By Dharmendra Patel , Community Service Pharmacist, Hounslow and Richmond Community Healthcare

Background to formation of service

Traditionally an MS (Multiple Sclerosis) specialist nurse has overseen the care of patients suffering from this disease. Due to a prolonged vacancy of the post, the service was forced to adopt a new approach in order to carry on providing care to these patients. MS is a disease that does affect multiple facets of a patient’s life, for example from their function to clinical health. It therefore followed that a multi-disciplinary approach would be logical and maximise patient care.

The Service referred to NICE guidelines and created a multi-disciplinary team of Physiotherapists, Occupational Therapists, Clinical Pharmacist, Speech and Language therapist and Clinical Psychologist while continuing the process of recruiting a nurse specialist as well.

Initial patient survey

A patient questionnaire was sent to registered MS patients who have used the MS nurses service, to ask their views on what their expectations were and which aspects of the service were important for them. A patient forum was also held thereafter.

The chart below demonstrates the responses, and highlights how patients’ highest expectation was for advice and reassurance, then medication advice followed by emotional and administrative support. The face to face forum reflected the same sentiments.


The most obvious challenge was in transforming a nurse lead service to an MDT lead service. The repercussions of this on patients who are used to dealing with one named person to a team were unpredictable.

Adopting a brand new structure without any ‘tried and tested’ service model was another challenge. There was a knowledge gap, and the entire team needed to upskill themselves, updating and revising their knowledge and current practices in MS management.

The clear advantages of this service are that patients no longer are reliant on one or two specialist practitioners and now can benefit from multi-disciplinary expertise, in a timely and holistic way. It is an innovative approach managing MS in a truly MDT fashion, a model that can be replicated across other healthcare groups. This is also in line with new strategies across the NHS, where MDT approaches are being advocated in many settings.

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