Who's who in the NHS
When trying to fit the various pieces of the health care puzzle together, it can really help to understand who’s who in the NHS and how they can help you manage your MS.
This A-Z list explains the role of some of the NHS professionals you may come across.
A-Z of who's who
Community nurses
'Community nurses' is the umbrella term for the different nurses who work in the community, rather than a hospital. This includes district nurses and community matrons, as well as practice nurses, who are normally based at your GP’s surgery.
Community nurses can visit you at home, in your care home or see you in clinics. They carry out assessments, advise on ways of coping with your symptoms and can help you get aids and equipment. They'll provide quite complicated care such as looking after wounds, catheters and bowel and bladder issues. They also and make referrals to specialist services (including home care and respite).
A district nurse might be your central point of contact, particularly if there is no MS or neurological specialist nurse in your area.
Continence advisers
Continence advisers can offer advice on managing your bladder and bowel problems, as well as information about products, drugs or exercises that may help you. You can self-refer to them, or you can ask your GP or MS nurse for a referral.
A continence adviser is part of a wider continence team at a hospital or clinic, which also includes a urologist. They can also do home visits.
Counsellors
Counsellors help people deal with emotional problems, depression and changes in mood. Counsellors allow you to talk about troubles or difficulties, and gain insight into how you might manage them. They can be based at your GP surgery or in a hospital or community centre.
You may find a counsellor useful when coming to terms with MS and the changing symptoms.
Dietitians
Dietitians are experts in nutrition and eating habits. They can help if you need to adapt your diet to help you lose or put on weight, or have other dietary problems as a result of your MS. They can also help you if you're having trouble swallowing.
Your GP can refer you to a dietitian in your area.
GPs
A GP (general practitioner) is responsible for your general health and will often be the first person you contact if you feel unwell or have general health questions.
GPs treat many hundreds of people, and it’s likely only a few of their patients will have MS, so they will not normally have detailed knowledge of it. However, they act as a gateway to other NHS services, so it’s still important to visit your GP as they can refer you to specialists and other health care professionals that can help. They can't give you disease modifying therapies (DMTs) to treat your MS but can prescribe meds for MS symptoms (hopefully after speaking to an MS nurse or neurologist).
MS nurses
MS nurses are qualified nurses with specialist training in MS. They are a great source of information and advice. They may also act as a link between hospital, community services and social services.
If you have not already been offered an appointment with an MS nurse, you can ask your GP or neurologist for a referral. Occasionally, MS nurses take self-referrals, which means you can ring them directly and ask for an appointment.
Ideally, you should be referred to an MS nurse as soon as you are diagnosed. They often become the first point of contact for any concerns about your MS (though a GP should be the person to contact about general health queries). They can be reached by email or phone, and some do home visits.
Not every area of the UK has an MS nurse. If there isn’t one in your area, it is worth asking if you can be referred to a specialist neurological nurse or someone else with an understanding of MS who can act as a central point of contact.
Find your local MS nurse on the MS Trust's map of local services.
The multi-disciplinary team
The multi-disciplinary team (or MDT for short) is the group of health care specialists that work together to help you manage your MS.
For example, the MDT could include a GP, MS nurse, neurologist, occupational therapist and dietitian – it will depend on the symptoms you have and what you need help with.
Neurologists
Neurologists are hospital-based doctors who specialise in the nervous system. Some are specialists in MS, while others treat a range of nerve-related conditions, with MS being one of them. They are responsible for diagnosing MS, prescribing any disease modifying therapies and making referrals to other services. Neurologists should explain the diagnostic process, the tests they may have to carry out and how long it is likely to take.
If you have MS, you will have seen a neurologist when you were diagnosed. When you have an appointment with a neurologist, you may not see the same one every time.
You can ask your GP or MS nurse to refer you to a neurologist at any time if you are experiencing new symptoms, or if there is a change in your condition – you don’t have to wait for a scheduled appointment.
Occupational therapists
Occupational therapists (also known as OTs) can help you to do activities that, because of your MS, you may have difficulty carrying out every day. This might include going to work, carrying on with a hobby, or basic tasks such as eating, bathing or getting dressed.
An occupational therapist can also suggest making changes to your home or workplace or special equipment to make life easier. They'll advise you on how to change the way you do a task, or show you how to relearn doing something. They can also help with balance, tremor and fatigue.
You may also see an occupational therapist if you apply for a grant from your local council to adapt your home, as they will complete an assessment of what you need.
Your GP, nurse or other health professional can make a referral to an OT. For more information about what OTs can do to support you, and how to find one, see the leaflet Occupational therapy and MS from the College of Occupational Therapists.
Pharmacists
Pharmacists (sometimes called chemists) are experts in medicines and how they work. They dispense your prescriptions at high street pharmacies, and can give advice on how to use prescribed medicines.
Pharmacists work in high street chemists and in supermarkets. They can also be based in hospitals, though often behind the scenes, advising health care professionals and preparing drugs. Sometimes they visit people at home or in care homes.
Pharmacies can give advice on:
- how to use prescription-only and non-prescription (or 'over-the-counter') medicines
- side effects of medicines
- which medicines may affect others.
Some pharmacies can also provide equipment.
You can find out more about paying for prescriptions on the NHS choices website.
Physiotherapists
Physiotherapists use exercises and movement of the body to help you move around better, feel less fatigue or pain, deal with muscle stiffness and spasms or improve your balance. Some physiotherapists are trained in conditions that affect the nerves (like MS) and are known as ‘neuro-physiotherapists’. Sometimes they can visit you in your home. Your GP or MS nurse can refer you to one.
If you experience a relapse or have new symptoms that affect day-to-day tasks, you might benefit from physiotherapy.
Psychologists and psychiatrists
Psychologists are specialists in how the mind works, with particular understanding of behaviour, emotions (such as depression or anxiety), memory and thinking. They don't prescribe medicines but teach you ways of coping better.
If MS is affecting your memory and thinking, you may be referred to a psychologist or a neuro-psychologist (one that's had special training in MS and other nerve-related conditions). A psychologist will try to identify both the specific problems you are experiencing, as well as your personal strengths that you can use to help you overcome or manage any problems.
Psychiatrists, on the other hand, are medical doctors who treat more serious mental health problems. They use a more medical approach than a psychologist. They usually prescribe drugs but sometimes use counselling techniques, too. A neuropsychiatrist has had special training in conditions (like MS) that affect people's nerves. Referral is through your GP or MS specialist.
Specialist nurses
Nurses can specialise in many different health care disciplines, including mental health. MS specialist nurses are just one type of specialist nurse.
If you experience certain symptoms for which there is a specialist nurse, you might be referred. For example, if you have bladder or bowel problems you might see a continence nurse. If you are prone to pressure sores you might see a tissue viability nurse or pressure care nurse.
If there is no MS nurse in your area, it is worth asking if you can be referred to a specialist neurological nurse.
Speech and language therapists
Speech and language therapists (SLT) are trained to diagnose and treat problems with communicating and swallowing. This can include difficulties speaking, following a conversation or finding the right word. They might see you in a hospital, community clinic or centre or in your home. Usually you'll be refered by your neurologist, MS nurse or GP but you might refer yourself to them.
Spasticity specialists
These are often consultants in rehabilitation medicine. They work in a clinic in a hospital and treat severe muscle stiffness.
Spasticity specialists prescribe treatments, including drugs (such as Botox or Sativex). The clinics where they work may carry out assessments by an occupational therapist and sessions with a physiotherapist. It may be possible for a patient to refer themselves to a spasticity specialist. Or an MS nurse, neurologist or GP can make the referral.
Neuro-rehabilitation team
They help people get back their independence after a nerve-related injury like an MS relapse. They might do visits to homes or day centres. They’re usually based in a hospital or clinic.
They offer physiotherapy, occupational therapy or speech and language therapy. The team might include a dietitian, psychologist or social worker. A GP or MS specialist makes referrals to them.
Orthoptists
They help test for and treat sight problems and eye movement issues, like MS-related double vision. They work in the eye department of a hospital or community clinic, or in a multi-disciplinary team (MDT).
Orthotics
They work in a hospital and help with some MS-related walking problems. They provide equipment to support part of someone’s body. This includes splints for foot-drop, and devices that support the foot or go inside shoes. They might offer Functional Electronic Stimulation (FES) for foot-drop.
Referral is directly through a physiotherapist or MS specialist, or by an MS nurse or a GP.
Urologists
A urologist is a hospital-based specialist who deals with problems with the bladder and continence. They work alongside continence advisers and can provide treatments such as Botox to manage bladder problems.
If you're male and have erection problems, you may also be referred to a urologist as these two bodily functions are closely linked.
Your GP can make a referral to your local continence service.
Wheelchair services
Often part of a hospital, they give manual and electric wheelchairs free of charge on a long-term loan (and do repairs). Each centre has its own rules on who qualifies for wheelchairs.
An assessment by an occupational therapist (OT) or physiotherapist can take place in a clinic, your home, day centre or care home.
Referral is through a GP, neurologist, district or MS nurse, physiotherapist or OT.
Palliative care team
They help with hard to control symptoms, especially pain. They can plan end of life care. But palliative care with MS is often about helping people and carers have a better quality of life, not getting ready for death.
A typical team has a palliative medicine consultant, palliative care nurse specialist, occupational therapist, social worker and physiotherapist.
This care happens in a care home, hospice, hospital or at home. The team works alongside the standard care the person with MS is getting.
To choose GPs and other health services use the NHS service directory:
