ESTABLISHING A REGIONAL MS MDT IN THE EAST MIDLANDS JONATHAN EVANS - - PowerPoint PPT Presentation

ESTABLISHING A REGIONAL MS MDT IN THE EAST MIDLANDS

JONATHAN EVANS CONSULTANT NEUROLOGIST, QMC NOTTINGHAM: jonathan.evans2@nuh.nhs.uk May 16th, 2019

NHS England Guidance 9/2018 (Updated 3/2019)

• Provides a framework to decision-making on MS DMTs
• Consistent, effective and safe prescribing
• Takes account of regulatory and commissioning status,

and NICE guidance (http://pathways.nice.org.uk/pathways/multiple-sclerosis)

Principles of Organisation of MS service for DMTS

• Every region should make ALL LICENSED MS DRUGS

available.

MS PRESCRIBING SERVICE: ≥1 CONSULTANT NEUROLOGIST WORKING WITH ≥1 MS NURSE

• All DMT prescribers must participate in regional networks with

requirements for audit, QC and education:

• DMT prescribing must be delivered by teams, and with

higher-risk DMTs there is a requirement for discussion at an

• ver-arching MDT meeting
• Services should be designed to facilitate collection of

mandatory data for audit and governance.

Stages in Development of MDT:

1.Evaluate Current Practice: Why?

Common to Most Tertiary Centres, we are already running a weekly MS MDT at QMC. However, current arrangements ad hoc:

• No single pathway for referral
• Consultants bring their own cases and record discussions individually
• A centralised record of outcomes is kept, but it is not searchable (rolling, tabulated document

in MS Word)

• Regional Centres do participate, but no established line for referral: Individual requests to MS

Consultants and MS Coordinator, “Drop-in” discussions etc. As Venue and Time already arranged and agreed, existing structure can be used both as a framework for a new regional MDT, and a forum for discussion of the form this MDT should take Develop a working group for MDT development with a designated lead and work to a Timeline

Stages in Development of MDT:

• 2. Determine scope and Identify ‘stakeholders’: Who?

MS Prescribing Service

• Derby
• Leicester
• Lincoln
• Northampton
• Kettering
• Chesterfield

Regional Neuroscience Centre Nottingham QMC

Regional hospitals without MS prescribing service

• Loughborough
• Glenfield
• Boston
• Grantham
• Newark
• Mansfield

Sheffield

(historical links)

Stages in Development of MDT:

• 3. Standard Operating Procedure: How?

NHS England specifies minimum requirements for MDT: ≥2 MS Specialist Neurologists ≥1MS Nurse Specialist PLUS Neuroradiology and Pharmacy Expertise NUH Set-Up: “CORE” MDT

• ≥3/8 MS CONSULTANTS (+Chair)
• ≥1/3 MS NURSE SPECIALISTS
• MS CLINIC CO-ORDINATOR

Formalise process: Job planning, Clearly defined roles, Standard Operating Procedure, Attendance Register, Timeline for Audit (Time, Venue already in place) + “NON-CORE”

• NEURO-RADIOLOGY LINK CONSULTANTS

AND PATHWAY

• NAMED NEURO-PHARMACIST

Streamline referral process and ensure good governance:

• Single Point of Access
• Standard Method of Recording
• Single Output

As a non-MS Specialist, aim to come up with a system that minimised administrative burden on MS Co-ordinator Develop a proforma for exclusively electronic referrals, and make this “linkable” through Trust intranet in hubs

UNIVERSAL MS MDT REFERRAL PROFORMA (1)

UNIVERSAL MS MDT REFERRAL PROFORMA (2)

MDT outcome recorded in “real-time” by Chair Protocol for referring patients for neuroradiology opinion – dovetailing with current NUH system

Completed form is then:

• 1. Saved in shared access drive as a single permanent record of outcome
• 2. (Securely) E-mailed back to the source referrer

Implementation and Feedback

Progress reports delivered at MDT, feedback reviewed and passed to “hubs” for comment Iterative and transparent process MS-MDT “Go-live” date for 5th June 2019 Audit lead to review process at 6 months:

• Number and distribution of referrals
• Attendance register/compliance
• Number of neuroradiology requests

Business case for dedicated Neuro- radiologist?

• % missing data in referrals

Summary and Conclusions

Described the stages in developing a fit-for-purpose regional MS MDT Illustrates the importance of a team-working, problem-solving approach in achieving this. Strengths of this approach: ü Utilises existing systems/structures: Achievable ü Single point of access and simplified channels of communication: Good Clinical Governance ü Standardised recording of outcomes: Facilitate clinical audit ü Addresses particular local challenges: Realistic and sustainable Personal Perspective: What is my experience of managing a cohort of MSologists?

What is my experience of managing a cohort of MSologists?

Summary and Conclusions

Described the stages in developing a fit-for-purpose regional MS MDT Illustrates the importance of a team-working, problem-solving approach in achieving this. Strengths of this approach: ü Utilises existing systems/structures: Achievable ü Single point of access and simplified channels of communication: Good Clinical Governance ü Standardised recording of outcomes: Facilitate clinical audit ü Addresses particular local challenges: Realistic and sustainable

THANKYOU… …AND QUESTIONS?

jonathan.evans2@nuh.nhs.uk