People with Multiple Sclerosis – and their relatives – often have questions and concerns about who is doing what when they go to see the various health practitioners.
It is relatively clear that your GP is medically responsible for your routine day-to-day health care. In the first instance you would normally go to your GP for advice about any symptoms, or other issues that concern you, even if they are not symptoms of Multiple Sclerosis. Most GPs will refer you on clinical grounds to support services for people with MS, often in the practice itself, such as nursing, counselling and, possibly, physiotherapy. Some larger general practices are also setting up multidisciplinary support clinics for patients with long-term conditions that, although not specifically targeted to MS, could be of value to people with the disease.
Once you have been referred to, and then been diagnosed by, a consultant (usually a neurologist), you would automatically become his or her patient as well in several ways:

• You will have hospital records with notes and records of your condition and, initially, you will be down as being under the care of the neurologist concerned.
• Most neurologists will want to assess you periodically – traditionally every 6 months – to evaluate how your MS is developing.
• Many neurologists are involved directly or indirectly in clinical
trials for new therapies for the disease or its symptoms, and they may invite you to participate in such trials, which will involve further regular monitoring or assessment (see Chapter 18).
• Particularly with the advent of beta-interferons and glatiramer acetate, possibly with certain other drugs, neurologists now have a special clinical role in dispensing them and monitoring their use.
• Both for clinical and economic reasons, hospitals are increasingly setting up MS clinics, and/or multidisciplinary support services for people with MS.

So, in principle, someone with MS could have an embarrassment of services, in both general practice and in a hospital setting! However, this is not usually the case. One of the major problems at present is that services are patchily distributed and relatively ill coordinated, and people with MS are having to take what is available to them. In the light of this unsatisfactory situation, the MS Society and leading neurologists have recently put together a minimum standard of service provision for people with MS, which they hope will lead to more consistent provision (see Appendix 2).
The situation is confused because, on the one hand, specialist advice and services in relation to your Multiple Sclerosis, i.e. those usually obtained through your neurologist and the hospital, take precedence over your GP’s advice on the disease; on the other hand, your GP is responsible – as we noted earlier – for your day-to-day health care. The problem then becomes what is an MS-related problem, and what is not. Technically the GP and the specialist should be in touch with one another, informing each other of developments in relation to your health. This does not always happen efficiently.
The best advice to you is to use whichever local services are most convenient and helpful for whatever problems you happen to have, and to press your GP and/or the consultant as necessary for other services that you feel have not been offered. To be frank, what most people with MS have found is that their GP is helpful, supportive and accessible, but is often not particularly knowledgeable about MS, and that the consultant is knowledgeable but not as supportive or as accessible as the GP. The advent of MS clinics with other professional staff, such as nurses, as primary advisers may provide more support in due course.
The idea of a ‘team approach’ to Multiple Sclerosis has gained considerable ground in recent years and most neurologists and hospitals support it. In the previous (‘non-team’) approach, a doctor, usually the neurologist, might have referred you independently occasionally for separate professional services, e.g. physiotherapy, occupational therapy, speech therapy or
nursing. People with MS often found this a problem in that each professional dealt with them independently; there seemed to be little communication between the different services, and no single person to whom they could turn for an overall view, apart from the neurologist who was not always accessible. You may be lucky in that you have access to an MS Specialist Nurse – their numbers are rising regularly.
The team approach, although it may have developed dif ferently in different hospitals, is designed to provide a more coordinated approach to the management of MS. Following your initial assessment, team meetings will be held between the professionals, sometimes involving you and/or your family. These meetings lead to the development of a management strategy of MS. The idea is that this should centre on your problems. Sometimes one professional person is appointed to liaise with you, as the first point of contact. Teams may involve the neurologist, a nurse, a physiotherapist, a speech therapist, an occupational therapist, a counsellor, an Multiple Sclerosis Specialist Nurse and possibly others.
In general, the move to a team approach has been helpful for people with MS, but problems of coordination between the professions still continue to exist, especially in the community. Sometimes you may be somewhat confused by the large number of professional staff you come into contact with. If you can establish one main person for contact – no matter what their professional discipline – it is very helpful. Note that many hospitals are still underfunded, and the team approach in itself will not lead to a change in that aspect, but they might be used more efficiently. In addition, there are often coordination problems between social services departments and other non-health-based support sources.