1. This presentation will ‘walk’ you through the pathway and guide you on how to use this tool

3. This column informs on symptoms experienced before and after diagnosis incidence/prevalence Self care and assessment Importance of preventing secondary complications hyperlinks to patient information Escalation thresholds helpful to the patient and family and Red flags that move the patient to primary care Red flags indicate urgent referrals to the next level of care

5. This column informs on the Primary assessment needs Diagnostics Treatments Rehabilitation and review Hyperlinks to GP guidelines For those patients who are undergoing pre diagnosis investigation or post diagnosis episodes and need Treatment for further relapsing episode Symptom management Post diagnosis and/or ongoing support Rehabilitation and review Red flags iindicate urgent referrals to specialist care

7. Red flags indicate urgent referrals to MS specialist team This column informs on the Specialist assessment Diagnostics Definitive treatments Rehabilitation and review Hyperlinks for clinical guidelines For those with confirmed MS and who need specialist monitoring assessment and review changes in treatment rehabilitation

9. This column informs on the MS specialist services as an in reach and outreach service Complex treatment options Complex rehabilitation Palliative and end of life care needs Hyperlinks for palliative and end of life care MS specialist services support primary care teams to keep care needs close to home, and maintain cycle of care Patient centred and relevant to their needs at any stage of the condition

10. Explaining the tiers and symbols on the pathway

11. The tiers Assessment and history Diagnostics Treatments Rehabilitation and review

12. The Symbols The person with MS Hyperlinks Clock starts Clock stops Move to the next part of pathway Open the menu for supplementary information and close menu Thresholds and decision aids

13. Using the mouse on the pathway When you scroll over a text box and see this grey text box it means there is further supplementary information (SI). Not all the SI will be visible on the global screen and will require you to open the menu in the left hand corner In the next few slides the areas highlighted in red demonstrate how you can access SI, and hyperlinks by clicking with the mouse. Each hyperlink will lead to relevant sites for this part of the pathway Some samples of information can be seen later in the presentation This is the “living” part of the pathway It will be updated and remain current to the needs of people with MS.

19. 2. Primary Assessment http://www.rcgp.org.uk/continuing_the_gp_journey /distance_learning/multiple_sclerosis.aspx 2.1 Decision aids The UK MS clinical management manual (2006) (MSSNA)

20. 3. Specialist Assessment NICE (2002)ABN Guidelines 2007 DoH Risk Sharing Scheme (2002) ABN Guidelines (2001) 3.3 Decision Aids: Disease Modifying Drugs