Developing an Integrated Multidisciplinary Care Pathway for MS in Hull, UK: Process, Application and Transferability

Thursday, May 29, 2014
Trinity Exhibit Hall
Sue Thomas, RGN RM DN Cert CPT BA (Hons) , Commissioning, Neurological Commissioning Support, London, United Kingdom
Jane Fowler, RMNH, RGN , Neurology Department, Hull Royal Infirmary, Hull, United Kingdom


Neurological Commissioning Support is a not for profit voluntary sector led organization. In 2013 we  developed and piloted, in partnership with the specialist multidisciplinary MS team in Hull, an integrated care pathway (ICP) for MS which will streamline and improve care outcomes for people with MS in Hull but also have wider application for any other specialist MS service.  Work on differing elements of the pathway is ongoing. Development of the initial pathway took place within the acute provider trust but also encompassed the five geographically diverse Clinical Commissioning Groups (CCGs) that use MS specialist services from this Hull provider trust. ICP’s are designed to improve the quality of care, efficiency and service planning by commissioners which the NHS in England is currently promoting. Development of ICP’s however is frequently viewed by clinicians as complex to achieve.


Production of a single integrated multidisciplinary care pathway that would identify care requirements in a person with MS from diagnosis through to end of life care.


Drawing on previous work into creating ICP’s our research included use of population data, hospital admission data and consultation with groups of multidisciplinary professionals and patients. Process mapping was used to identify current care pathways within the Hull provider area and illustrate where services could be streamlined and improved for greater service efficiency and better patient outcomes. Separate pathways were developed across the main areas of MS care, for example at diagnosis, the introduction of disease modifying therapy and rehabilitation. Common problems patients experienced that had resulted in the need for medical and nursing intervention were also identified. Pathways were also developed for these areas and included relapse and urinary tract infection.


The pathway has been developed to improve services in Hull but the process is also transferable and has enabled other clinicians to understand the process for development. Researching and creating the ICP has revealed good practice, where patients perceive quality and simple solutions for greater service efficiencies.  This pathway clearly demonstrates where service improvements and improved patient outcomes can be made.


ICP development overall is time consuming and some aspects more challenging than others to implement. Barriers to implementation that can hinder progress in development are limited clinician time and capacity to undertake the work; resistance to change and involvement in the work as well as poor communication and coordination between MDT members.  Behavioural as well as service change is therefore essential for implementation. To aid transferability the methodology for this development has been documented into manageable steps accompanied by practical online resources.