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South West MS teams join forces to improve care for people with MS 

In December 2018, four MS Consultants met to discuss the potential to develop a network to support services for people with MS across the South West Peninsula.

Representing Royal Cornwall Hospital, Royal Devon and Exeter, Torbay and South Devon, and University Hospitals Plymouth they recognised that such a network could:   improve and protect their services 

  • mitigate risks 
  • solve challenges 
  • create opportunities that would benefit local people with MS and the teams supporting them. 

They all agreed the timing was right to pursue this ground-breaking initiative.    

Setting up the network

Working with a small group representing their wider clinical teams, people with MS and commercial partners they developed and shared an initial vision:   

To establish, for people with MS, an exemplar network for coordinating care which delivers highly effective, efficient, coordinated and consistent processes for diagnosis, treatment, monitoring and data collection. 

In September 2019 they held an event to engage professionals involved in MS care delivery within the network region.

There were more than 60 attendees at the event including people with MS, neurologists, specialist nurses, allied health professionals, administrators, NHS England and NHS Improvement, local MS centres, the MS Society, MS Trust and commercial partners. 

Workstreams to improve care 

As a result, six focussed work streams started in January 2020 looking at 

Shared Clinical Management Platform: Integration, data sharing, monitoring and research.

21st century multi disciplinary team (MDT): Wider input, sharing expertise, consistent and inclusive decision making and holistic care. The network will start the regional MS MDT pilot this April. 

Patient Activation: A role to support patients/referral to services, use of technology and self-management. We propose the creation of a regional signposting hub to better support and communicate with people with MS.

Improved and Consistent Pathways: Equity of access and care, reducing avoidable delays/admissions.

Workforce and Education: Active MS network, coeducation between MS and non-MS teams, sharing best practice, future proofing services. The MS specialist nurses are developing a model that plans appropriately for retirement and potential gaps in service to develop new MS Nurses.

Coordinated Research: Local access to regional studies, shared infrastructure, regional cohort, income generation. 

What’s next for the South West MS Network? 

The South West MS Network has created an ambitious, innovative plan to deliver our vision: A connected, improved, future proofed service to deliver high quality, improved and consistent care to people with MS.  

Having a shared clinical management platform, agreed pathways and a coordinated approach to decision making and clinical trials will enhance the services within the peninsula. And it provides a template for pooling investment and sharing services across Trusts. 

This project is also novel in that it seeks to work with all partners in a collaborative way to bring about change while focusing on the long-term sustainability of the network.