Demonised and demoralised
To maximise outcomes for people with MS, we need to make the partnership between hospital-based specialist services, GPs and community-based HCPs work.
In clinic yesterday, one of our clinical nurse specialists and I discussed how much work we seem to be doing in relation to the general health of people with MS. These activities need to be done in general practice. This change seems to be a post-COVID phenomenon. I suspect it is driven by manpower issues (fewer GPs), increasing difficulty getting to see a general practitioner (GP) face-to-face, COVID-related disruption in well-women and well-men NHS health checks, ascribing all medical problems to being due to MS and my observation that some pwMS use our MS Service to triage their health problems.
We can’t take on the responsibilities of general practice. This, however, raises the question of the GP's role in MS management and whether they have enough expertise to help manage MS in general practice. I, therefore, propose setting up a GP training course to upskill GPs to do so. The idea is to run short online seminars of 15 mins each to cover well-defined topics that I think are important in diagnosing and managing pwMS. The following is an initial list of 24 topics that could be covered in 6 hours (24 x 15 mins) over six months.
I need your input. Do you think there is a need for a GP course like this? Any ideas on how to get GPs to enrol on the course? And are there topics that I have not covered that you think should be? And finally, do you think pwMS should be able to attend the course and learn alongside their GPs?
Proposed general practice MS minicourse
The 101 of MS for GPs - what you need to know?
MS DMT update for GPs - treating-2-target and beyond
Red flags - when to refer patients for a neurological assessment?
Do you know how to judge your local MS service’s performance?
What is the role of the GP in family planning for someone with MS?
The GPs role in derisking disease-modifying therapies, vaccination and pharmacovigilance
The GP’s checklist when managing MS-related fatigue
The GP’s role in managing depression and anxiety in patients with MS
MS bone health and falls prevention in people with MS
How to activate and educate your patients to prevent and manage the MS bladder
Managing MS-related constipation in general practice
The GPs role in managing MS-related spasticity
How to manage MS-related sleep disorders
How to screen for and manage MS-related sexual dysfunction in general practice
Prevention of pressure sores in people with advanced MS
How to identify emotional and physical abuse in people with MS
Managing social isolation and loneliness in people with MS
Social determinants of health - can GPs help?
Diet and MS - what advice to give?
Exercise and MS - what advice to give?
Which patients with MS do you need to see face-2-face? What to look for when you see them?
Comorbidities and MS - what to do about them?
MS prevention - what advice to give patients about reducing their children’s risk of getting MS?
Advanced directives; how to bring up the discussion?
Please note I am not complaining about GPs. From a personal perspective, having nearly been killed in a pedestrian road traffic accident and sustaining major trauma in 2020, and having come through a recent melanoma scare, I only have praise for how my GP has looked after me. Thank you, thank you.
In my opinion, GPs are doing a fantastic job in an extremely difficult period post-COVID and in a toxic political environment that blames them for the current NHS healthcare crisis. Therefore, I would greatly appreciate your input if you are a GP.
To maximise outcomes for people with MS, we need to make the partnership between hospital-based specialist services, GPs and community-based HCPs work. We will not be able to change the configuration of the NHS, but we can make it work better for everyone. I am convinced by doing this we will also improve our job satisfaction.
If you are interested in discovering more about GP's troubles, please read the following article.
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General Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Barts and The London School of Medicine and Dentistry or Barts Health NHS Trust. The advice is general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional who will be able to help you.
I work as a nurse practitioner in General Practice and until my diagnosis last year I knew very little on MS. I think its a great idea. Currently we do a lot of our training through NB Medical so it may be an idea to work in partnership with this group so that you have email access to GPs
Melanie
As most GP’s will see a limited number of patients with MS I definitely feel your courses should include pwms too. Self advocacy is so important and the knowledge of when or how a GP can help is invaluable in the current climate.