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IntroductionThe UK MS service audit builds upon GIRFT’s recommendation for disease-specific data. Here, we address caseloads managed and use of databases.AimTo document the workload of MS Teams and how they record their patients.MethodsWe asked all MS services to complete service questionnaires, supplemented with individual clinician interviews. Specifically, we asked about total caseload, DMT caseload, annual service expansion, accuracy of their estimates and use of databases.Results70 MS centres care for 105522 people with MS, 85% of the estimated UK MS population.Estimates were large and variable for total caseloads (median caseload/service=1300 patients, range 96–5500, SD=1247) and DMT caseloads (median = 545 patients, range 79–2300, SD 577). Estimated annual service expansion varied between 5%-14%. Only 20% of participants graded these estimates as “very accurate”. 98% of participants used an MS patient database. However, many questioned their validity. Few used a prospectively updated database facilitating clinical practice. The vast majority used Excel- based patient-lists, mostly people on DMTs, for safety monitoring.ConclusionsEnhanced digital maturity and linked data sources will facilitate patient identification, clinical decision-making, service planning, management and outcomes. We recommend MS Teams are supported to advance along the continuum of digital maturity, from their current position, to prospec- tively maintained accurate lists of all MS patients, through routine visualisation and analysis of longitudinal minimum datasets, to networked clinical management systems.Acknowledgements.Neurology Academy david.rog@srft.nhs.uk

IntroductionThe UK MS service audit builds upon GIRFT’s recommendation for disease-specific data. Here, we address MS-specific Multidisciplinary Team (MS-MDT) meetings, an NHSE requirement for services prescribing disease modifying treatments (DMTs), although the wider MS-MDT parameters are less clear.AimTo document the characteristics and variability in UK MS-MDTs.MethodsWe asked all MS services to complete service questionnaires, supplemented with individual clinician interviews. Specifically, we asked about occurrence, frequency, who attends, and numbers and types of patients discussed at, MS-MDTs.ResultsForty-six of the 70 centres (68%) had an MS-MDT, 63% were weekly. Neuroradiologists attended only 49%, MS Coordinators 79% and Neuropharmacists 50%, of meetings. Neurology SpRs (73%) and Research Registrars (62%), attended the majority of MS-MDTs. A mean of 9 patients (range 1–40, SD 7) were discussed, predominantly complex patients and/or those considered for high efficacy DMTs.ConclusionsThere was considerable variation in the occurrence, frequency, composition and types of patients discussed at UK MS MDTs. Neuroradiologists absence is concerning, given the central role of MRI in MS clinical decision-making. Neuropharmacists and MS coordinators absence, limits the wider benefits from MS Team members. The MS-MDT is a regular touch point and a significant educational opportunity for the whole team, including trainees. We recommend that the UK MS community defines the param- eters of an MS-MDT so that these can be consistently implemented, through job-planning, across services.davidrog@srft.nhs.uk80

IntroductionThe UK MS service audit builds upon GIRFT’s recommendation for disease-specific data. Here, we address MS disease modifying treatment (DMT) prescribing.AimTo document MS Teams’ DMT prescribing.MethodsWe asked all MS services to share their MS DMT prescribing for the 2018/2019 financial year. We computed: the proportion of people living with MS (PLwMS) on DMTs; drugs prescribed, ratios of higher- to-lower potency drugs, costs to the NHS.ResultsTo date, 49/70 (70%) services have shared data (none declined our request). They treated >21,000 people with DMTs. The proportion of PLwMS on DMTs varied 5.5-fold (range=14.6% to 79.4%; mean=39%).Most services (34/49; 69%) had unrestricted prescribing. These services varied 5-fold (9% to 50%) in the proportion of people prescribed monoclonal antibodies (alemtuzumab, natalizumab, ocrelizumab).The total annual spend from 49 services exceeded £261 million (extrapolated to £373million from 70 services). Mean DMT spend/patient was £12,096 but varied 3.6-fold (£7,116 to £25,833).NHSE quote the total annual increase in DMT spend was 10% in 2019/2020.ConclusionsDMT prescribing variations are expected, but important, if associated with differing outcomes. We recommend the substantial DMT spend and its increase, demands UK investment to: maximise processes (full data reporting to prescribers) and outcome measurement (including dashboard of longi- tudinal and peer-benchmark prescribing practice, eg induction vs escalation approaches and sequenc- ing) to provide optimal real world evidence to guide prescribing.AcknowledgementsNeurology Academy david.rog@srft.nhs.uk79

IntroductionWhilst GIRFT highlights long-recognised variations in MS service provision and disease modifying treatments (DMTs) prescribing, sources of variations weren’t explored.AimThe UK MS Service and Prescribing Audit was undertaken to better understand MS care, contextualise sources of variation and facilitate service development.MethodsWe asked all MS services to complete service questionnaires, supplemented with individ- ual clinician interviews covering; caseload, databases, staffing, neuroradiology, MDT, coping. We also requested anonymised blueteq or internal DMT prescribing data for 12 months to 31st March 2019.Results70 MS services participated. They care for >105,522 people with MS, ≈85% of the estimated UK MS population. To date, 49 MS services have provided DMT prescribing data for over 21,000 patients, a combined spend of over £261 million in the financial year to March 31st 2019. Consistent findings, detailed in five other abstracts, include: high caseloads, inconsistent team structures, low staffing levels, limited data collection and usage and access to support services.ConclusionsThis audit illustrates significant engagement from the UK MS community, with a representa- tive sample, providing a real opportunity to effect change. We recommend working across the UK MS network with multiple stakeholders to (1) maximise influence for change, (2) develop new ways of working to deal with workload, including enhancing data maturity and optimise team structures, and (3) build MS team resilience and sustainability.Acknowledgement.Neurology Academy david.rog@srft.nhs.uk

ObjectiveTo examine the association between socioeconomic status (SES) and prescription of disease-modifying treatments (DMTs) in people with multiple sclerosis (pwMS).MethodsA cross-sectional study was conducted among 734 pwMS aged ≥18 years attending the neuroinflammation service at The Royal London Hospital (Barts Health NHS Trust) between 1997 and 2017. SES was determined by patient income and education extracted from the English Index of Multiple Deprivation. Multinomial logistic regression was performed to assess differences between SES and prescription of DMTs.ResultsDMTs were categorized as follows: moderate efficacy therapies included Glatiramer Acetate and Beta-Interferons (n=81, 11.04%), high efficacy therapies included Cladribine, Fingolimod and Dimethyl Fumarate (n=409, 55.72%), and very-high efficacy therapies included Natalizumab and Alemtuzumab (n=244, 33.24%). Medians for income and education deciles were 4 (IQR 3–7) and 6 (IQR 4–8), respectively. Patient income was not associated with increased odds of being prescribed high efficacy (OR, 1.02; 95% CI, 0.91–1.14; p=0.814) or very-high efficacy DMTs (OR, 1.01; 95% CI, 0.90–1.14; p=0.732). Similarly, patient education was not associated with the prescription of high efficacy (OR, 0.96; 95% CI, 0.84–1.10; p=0.585) or very-high efficacy DMTs (OR, 0.96; 95% CI, 0.84–1.10; p=0.538).ConclusionsSES was not predictive of prescription of DMTs in this single-centre study. It would be of interest to compare our data with other MS services, and to map these results onto the inequity in access to DMTs across the UK.