2. NHSE commissioning
Background to NW London services
The need for change
The groundwork
How we did it
Key people
3.
4.
5. Specialist Neuroscience centre
A hospital where both neurology and neurosurgery services are delivered. Each centre has a
multidisciplinary MS team made up of MS neurologists, MS specialist nurses and MS or neuro-specialist
allied health professionals (AHPs). There are 25 neuroscience centres in England, as designated by NHSE.
MS prescribing centre
A type of neurology centre not designated as a neuroscience centre by NHS England but which prescribes
disease modifying drugs. An MS prescribing centre will have a multidisciplinary MS team made up of one
or more MS neurologists, MS specialist nurses and MS or neuro-specialist allied health professionals.
Around 60 neurology centres in England are MS prescribing centres.
Neurology centre / district general hospital (DGH)
A hospital which provides general neurology services, but not neurosurgery. Many people with MS will be
diagnosed in a neurology centre or DGH by a general neurologist. Their care should then be transferred to
a specialist MS neurologist at a neuroscience centre or MS prescribing centre.
Neuro-rehabilitation centre
Community services
7. • Based at Charing Cross Hospital
• One of largest MS treatment centres in UK
• Over 3500 patients
• 3 MS nurses / 3 infusion nurses
• 4 consultants
• 1prescribing MS pharmacist
1400 on DMTs
8. Nurse started in post 2006 - no MS service at this point in time.
MS Patients seen in many different clinics by general neurologist, rehab
consultants or by GP's, mostly not seen at all.
Identified a small group of 40 MS patients known to the Rehab service
Monthly clinic run from the Rehab unit
MSN role split between rehab and MS- collaborative working.
Originally very small numbers. Word of mouth – increased referrals.
MS nurse became a prescriber in 2009.
2014 - MS clinics running on alternate weeks. 240 patients
2015 - new MS consultant in post
2016 - 2nd MS nurse post - Full time band 7.
2017 - weekly MS clinics - 470 patients.
Strong attachment to the Rehab team and links with community colleagues
mean the patient experience managed very holistically.
9. Seen at Hillingdon - Eligible for DMTs
No access to Blueteq
Consultant referred to themselves at CX
Patient had to wait for an appointment
Then referred on to MSN for treatment
Treatment delays
10. Nurse to nurse referral
Imperial complete Blueteq
Imperial prescribing DMTs
Follow up & ongoing care at Hillingdon
Disjointed service for patients
Increased workload for both teams
11. MS nurse at Hillingdon engaged with key
stakeholders at the trust.
Included business managers, clinicians &
pharmacy staff.
Assessed the impact of the proposed change
on existing services and how it would cope
with the additional demand.
Ensure service was robust enough to continue
to provide a service to all MS patients, not
just those on DMTs.
12. Background to THH service
Provided data on :
MS attendances at THH
Existing prescribing at CX – number of
patients on each drug – and associated costs
Projected numbers on each drug – and
associated costs
Include attendances for monitoring (?income)
Overall costs to be transferred ? £££
15. Blueteq enabled
Money moved from Imperial – Hillingdon plan
Prescribing & monitoring of all 1st line drugs
at Hillingdon
Infusions at Imperial
Complex cases discussed at MDT
Support & learning for both teams
16. Nurses & clinicians
Business managers
Pharmacy – Neurology pharmacist
Clinical Commissioning Pharmacists (CCP)
Contract Services Managers (Service Level
Agreement, SLA) at each trust
Supplier Manager for NHSE region
Programme of Care lead for NHSE region
Complex – requires a guide!
20 page document on Who pays for what, how centres are defined, explains contract models & tariffs & how all this impacts on MS services
Outline of Imperial MS service with patient numbers on each treatment etc
Largest number of patients in the UK on Tysabri
Consultants believe in early & aggressive treatment