Nurses who specialize in treating multiple sclerosis (MS) patients in the U.K. are handling heavier caseloads than recommended or preferred, resulting in patients going without the necessary care and support they deserve, the MS Trust reports.

Particularly, the 2018 report notes that newer treatments require more complex and careful monitoring. However, it found that each MS Specialist Nurse (MSSN) handles 379 patients on average, rather than the 315 the group considers a “sustainable figure.”

The October report, “MS Specialist Nursing in the UK 2018: Results from the 2018 MS Trust Nurse Mapping Survey,” builds on  the MS Trust’s 2016 survey. It is based on data from responses by MS specialist nursing teams, or nurses with an MS-only caseload, across the U.K.

In 2018, the Trust found that — although the number of whole-time equivalent (WTE, a unit of measure that converts part-time working hours into full-time equivalents) of MS specialist nurses (MSSNs) increased by up to 4% between 2016 and 2018 (from 241 to 250) — this increase “has not been rapid enough to counteract the lower sustainable caseload figure and increase in the number of people with MS.”

Currently, the recommended caseload for MSSNs is 358. But work by the MS Trust show that as patient care and demands on MS nurses changed, a lesser number is more suitable.

“The existing sustainable caseload of 358 people with MS for each WTE MSSN was recognized as too high. Work recently commissioned by the MS Trust … recommended 315 as more realistic,” the report states.

Furthermore, a nearly a quarter of MS patients (more than 26,000 people) live in areas where caseloads are more than twice the recommended number. And, working on with an estimate of 127,000 total MS patients in the U.K., the Trust report found that 77 percent “live in areas where caseloads are in excess of 315 per WTE” nurse specialist.

This excess suggests MS patients there are missing out on proper care, and symptom and treatment management.

The report also found considerable variation in the degree of nursing provision across the U.K., with the most significant care shortages spotted in England and Scotland.

“The landscape has changed significantly since our last MS Nurse mapping exercise in 2016. We now have more disease modifying drugs being made available, more requirements for complex monitoring and many MS nurses carrying out non-specialist work,” Jo Sopala, director of health professional programs at the MS Trust, said in a news release.

“Whilst we welcome the increase in the number of nurses shown in the 2018 census, the increasing complexity of the role and the additional tasks MS specialist nurses are expected to take on, mean that even more MS nurses are needed,” Sopala added. “As a consequence of this, the number of people with MS living in areas that don’t have enough MS nurses is growing.”

The Trust recommends that “between 61 and 105 new MSSNs” are needed countrywide to reach one nurse for every 315  patients.

“[A]lthough progress has been made in the last two years, there is still a lot more to do,” its report concludes.