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A commissioning pathway for MS

Way Ahead 2008;12(4):3

Across the UK there are at least 85,000 people with MS. However knowledge in the primary care arena is low - each GP is likely to have only 1-2 people with MS on their list, and expertise amongst commissioners is understandably poor.

This is a major concern as with the current structure in the NHS the budgets are based within the Primary Care Trusts (PCTs) and commissioners also based in the PCTs are responsible for agreeing contracts with the service providers. For commissioners to have a low level of understanding is therefore a major barrier to adequate service agreements, and implementation of the NICE clinical guidelines for MS management.

To resolve this problem the MS Trust agreed to lead a group to produce and test a commissioning pathway for MS.

The organisations involved include:

Department of Health led by Professor Chris Clough the lead for the Long-term conditions NSF
Association of British Neurologists
Royal College of Physicians
Royal College of Nursing
MS Trust
MS Society
The four pharmaceutical companies with drug therapies for MS
Commissioners from across the UK

All parties were involved at all stages.

Pathways for Health were commissioned to undertake the production of the pathway using their software that is already used within the NHS for many of the 18 week pathways.

Development of the pathway

A core group comprising: Dr Peter Brex a neurologist from Kings College London, Nikki Embrey, the MS specialist nurse from University Hospital North Staffs and Vicki Matthews the MS specialist nurse advisor for the MS Trust were recruited to produce the first draft. This was then reviewed by a wider group involving nominated representatives from all the above organisations. Several rounds of iteration were undertaken amongst all parties.

In June 2008 a consensus event took place in London involving 55 people including clinicians, academics, commissioners and people with MS. At that meeting further changes were made to the pathway and subsequently full proofing has been undertaken.

At the consensus event both clinicians and commissioners recognised the challenges they each faced. They also recognised the equal opportunities for improving MS care; and thus the major benefit of the MS pathway.

The pathway has been presented, at senior level, within four SHAs to date and in all cases was very well received. It is now keenly awaited by commissioners and clinicians alike. The pathway will be accessible via the Pathways for Health website and the MS Trust website in due course.

This MS pathway is a very good example of genuine partnership working, linked to the implementation of the NSF for Long-term conditions1. Commissioning is one of the key drivers in the current NHS and this MS pathway will be well received by the commissioners who currently have little knowledge of MS. It may also provide a framework for neurology commissioning in general.

We hope that for all clinicians this pathway will be a useful tool for discussion, guidance and action in developing better services.

The software allows the pathway to be localised. Further information about how to access a licence to develop the pathway for your locality can be accessed via the Pathways for Health website. Licences to develop pathways can be purchased on an individual basis or on a whole PCT, PBC, SHA wide basis.