Alison Leary- MS caseload update

1. MS caseload update
Alison Leary PhD FRCN FQNI
Professor of Healthcare & Workforce
Modelling
@alisonleary1

2. Patients really like specialist nurses but do we
really need them? I don’t really understand
what they do.
• A substantial, experienced workforce
• Varies in role-super specialists, LTC
case managers and community nursing
• Largely untapped resource.

4. Working out workload
• Estimated to be 290 MSSN in the UK. 163 responded
to a request for workload data RR~56%
• Modelling of workloads, compared to other LTCs
quant and qual analysis
• Checked with people who do the work (consensus
group)

5. Work done
163 MSSN equivalent of 139.8 whole time
equivalent (WTE) posts provide 806 clinical
sessions per week. A mean of almost six
clinical sessions per WTE per week.
Number of sessions 0 1 2 3 4 5 6 + Total
Sessions
Nurse-led outpatient
clinic
6 22 50 32 17 11 8 389
Consultant-led
outpatient clinic
62 28 7 3 0 0 2 63
Joint clinics 48 44 9 4 1 0 1 84
Advice line 16 19 21 10 9 16 33 565
Telephone clinics 24 34 18 10 7 7 19 277
Virtual clinic 75 6 7 2 2 0 1 48
Inpatient working 39 58 8 2 3 1 4 121

7. Thematic analysis
• “I do see patients in whom MS is suspected
but have yet to be given a formal diagnosis by
their MS consultant. This is clearly a time of
great emotional distress and sadly patients
can wait as long as 6 months after seeing a
general neurologist to being seen by an MS
specialist consultant. For some patients they
resent the missed opportunity to commence a
DMT early.”
• “I feel it would be quite overwhelming for the
patient if I was present prior to diagnosis is an
MS Nurse. I think the care prior to diagnosis is
best performed by the Neurologist.”

8. Work left undone (n=97)

9. Interesting stuff
• This group ~644 hours of unpaid overtime
worked per week (17.2 WTE, £12,628 pw or
£656,699.68 PA)
• Most (90.2%) recently had undertaken CPD
• 28.8% of respondents had a prescribing
qualification.
• Mostly positive in their experience of working
in MDT with 58.6% agreeing that they work in a
functional, supportive and efficient MDT.
• 24.2% of respondents would only challenge
some members of the team while 36.2% felt
uncomfortable challenging some members of
the MDT

11. Pipeline

12. So what’s the number?
• Looked at workload not caseload
• Previous 358 but MSSN with this number left work
undone
• Suggest lowering this to 315 BUT….
• Adjust up or down for different factors such as travel,
complexity and casemix.

13. We say who we are, not what we do
Compassion
Empathy
Virtues i.e.
courage
Skill,
knowledge,
expertise,
alleviation of
suffering
Psychological
care

15. Jacki Smee, Helen Owen, Mary Fraser, Karen
Vernon, Esther Cockram, Annabella Pearce, Jane
Metcalfe, Carolyn Cairns, Fiona Mullen, Jenny Pye,
Bethan Tredwell, Mary Fraser and Carmel Wilkinson
and the members & secretariat of UKMSSNA,
All the staff at the MS Trust!

16. “If you think its expensive to hire
a professional to do the job,
wait until you hire an amateur!”
Red Adair
alisonleary@yahoo.com
@alisonleary1