Virtual Consultations for Nurse Led MS Clinics: Here to Stay?

Introduction

To understand why this question is being asked it’s important to understand how the West Midlands Rehabilitation Centre (WMRC) functions and what services are provided. We provide rehabilitation only through a multitude of different services:

• Specialist clinics (including Multiple Sclerosis, Spasticity, Neuromuscular, Young Adults, Intrathecal Baclofen, Non-Traumatic Spinal Injury)
• Wheelchair Services
• Prosthetics
• Functional Electrical Stimulation
• Orthotics

Our Multiple Sclerosis (MS) clinics at the WMRC take 3 different forms:

• Multi-Disciplinary Team clinic, consisting of Consultant in Rehabilitation Medicine (CRM), Specialist Physiotherapist (SPT), Occupational Therapist (OT) and Multiple Sclerosis Clinical Nurse Specialist (MS CNS). All new referrals are seen in this clinic and follow up’s identified as requiring MDT input.
• Physiotherapy only clinic. Currently these are mainly on an ad-hoc basis whilst the centre reviews capacity. Identified via MDT clinic.
• Nurse only clinic. These patients are identified via the MDT clinic and have mostly nursing or quality of life needs. Patients can be referred back into MDT clinic should the need arise. This is at the MS CNS discretion.

Currently, we have 244 MS patients on our workload, 88 of these are allocated to nurse led MS clinic.

All services have struggled during COVID-19 and the various lockdowns with the inability to review patients face to face (F2F) and subsequent staffing issues caused by re-deployment. As you can imagine, many of the services provided by WMRC require F2F input. Consequently many of our services have long waiting lists of patients waiting to be seen. As management reviews the capacity at the centre, many services are jostling for clinic space and adding in extra clinics to try to bring down their waiting lists.

Therefore, can I support my colleagues to bring down their waiting lists by providing my patients with ongoing virtual consultations? It is after all our MS patients that are waiting to be seen by these services. Therefore, what I want to consider is the following:

• Are virtual appointments the way forward – are they clinically effective?
• Do our patients feel that they are able to discuss all their needs effectively via virtual appointment in comparison to F2F?
• What form do they want their future nurse led MS appointments to take – phone, video or F2F?
• If we’re continuing with virtual consultations what do our patients want us to provide them with? How can we best support them in between appointments? What service improvements can we make to ensure that our patients feel seen, supported and listened to?

Ultimately by asking our patients whether they are receiving the care they need and then improving things on the basis of what they tell us will help our patients feel more supported and better cared for.

Method

I decided to ask the questions to a group of pwMS who have had review with myself in the past 6 months. I made contact by telephone and went through the short 5 question questionnaire with each one that answered. I felt it important to just concentrate on those patients reviewed by myself and not the previous MS CNS so that there would be no factors that might cause variability in the clinical effectiveness of virtual consultation results.

Results

This has been a productive audit as it has provided me with information relating to:

• Whether virtual consultations have been effective in addressing the needs of pwMS during the pandemic.
• What their requirements are moving forwards. What the best method is for them individually to receive a timely follow up and full assessment of their needs.
• What patient information needs they have and how we can make them feel more supported, involved and informed in their care. As a team it is likely that we will need to review patient information and see what needs updating, what is missing and do a more in depth assessment in this area. We also need to review whether producing a 6 monthly or yearly newsletter is feasible and if it will fit within the clinic workload.
• As clinic capacity increases and we start doing more F2F clinics this audit will lead to a more effective way in which we run our nurse led clinics in which we offer personal choice over how they attend their appointments. Patient choice provides more responsive, personalised and efficient service while at the same time improving equity.
• The vast majority of our patients feel confident in making contact with us should they need to, have our contact details and have the means to make contact.

Conclusion

The COVID-19 situation will continue to evolve but hopefully we are moving towards reinstating services to the level that we used to. However, it’s also a time for reflection and consider whether the way we used to do things is actually the right way. Engaging with patients and using their experience to make decisions regarding our service is a positive way to ensure that we provide the best care we can. This audit will ultimately not only help restructure our service and the way we deliver our nurse led MS clinics but will also have a positive impact on the other services within our centre. It will aid in giving our patients the confidence and trust to approach us for support outside of clinic appointments and it’s reassuring that the majority are happy to make contact and have our details close to hand.

There is still more work to do in regards to patient information and support outside of clinics but the feeling is optimistic that any service improvements we make will be beneficial, patient focused and will be embraced as a positive measure by our patient group.