Rachel Dorsey-Campbell describes how the MS service at Hillingdon Hospital was expanded to become a full MS prescribing center. Originally, MS patients from Hillingdon were referred to Imperial College Hospital for treatment with disease-modifying therapies. This caused delays and a disjointed service. By engaging stakeholders from both trusts and obtaining funding transfers from Imperial, Hillingdon was enabled to prescribe and monitor first-line MS drugs locally while continuing complex case discussions through a shared multidisciplinary team meeting. This change improved access and care coordination for MS patients in the local area.

1. Rachel Dorsey-Campbell
Senior Neurosciences Pharmacist
Imperial College Healthcare NHS Trust

2.  NHSE commissioning
 Background to NW London services
 The need for change
 The groundwork
 How we did it
 Key people

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

6. Hillingdon
Harrow
Brent
Barnet
Hounslow
Richmond
Wandsworth
Merton
Haringey
Ealing
Redbridge
Barking
Bexley
Greenwich
Lewisham
Newham
Camden
South
-wark
Lambeth
West-
minster
Hackney
Waltham
Forest
Isling-
ton
City
Havering
Bromley
Tower
Hamlets
Sutton
Croydon
Kingston
Enfield

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 ? £££

13.  Shared pathways & guidelines
 Shared monitoring schedules & parameters
 Cross–trust weekly MDT
 Discuss complex cases & treatment escalation

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

18. THANK YOU !!