Many of you who have requested an opinion from Barts-MS, and don’t live in the Barts-MS catchment area, have discovered that your referral to our service has been rejected. I have a handful of complaints from patients wanting to see me in the last week or so. The reason is that we can’t cope and we are now putting our existing patients at risk!
We have just completed a review of our MS Services and have come to the conclusion that without more resources we are unable to cope with the rising demand.
As you can see from the graph above the number of patients on DMTs at Barts-MS has quintupled in the last 7 years. Hidden in these figures is the fact that we have had no increase in staff to manage this increased caseload. In addition, close to 70% of our patients on DMTs are out-of-area. These out-of-area patients are being managed by our service rather than their local MS team. The consequences of this are that the quality of our MS service is suffering and we are now having difficulty looking after our ‘own patients’.
Another factor that is going to have a big impact on our service is the licensing of DMTs for active progressive MS, i.e. ocrelizumab for PPMS and siponimod for SPMS. This means more visits, more MRI monitoring and many more patients on DMTs. Something has to give!
Increasing our staff complement is not easy either. Barts Health NHS Trust has been under special measures for several years and has one of the largest deficits in England. Business cases to expand our MS Services get submitted and are held-up for years. For example, it has taken us over 3 years to get our Trust to support an MS clinical nurse specialist in Newham. This is despite the fact that the salary of this post will be covered by the MS Trust for the initial two years and that 50% of the salary after that will be covered by the local clinical commissioning group or CCG.
To try and address the service issues we have just submitted a grant to the Big Lottery Fund to transform our service into a distributed network. The configuration of the service will be a co-design project with patients, GPs and HCPs working with people with MS. The good news is that we are doing this with All-Together-Better, an innovative NHS team, who have experience in transforming services.
So Barts-MS would like to apologise to you all that we are not going to be able to take on the management and treatment of any more out-of-area patients with MS unless something drastically changes with the funding model in the NHS.
We hope you understand.