You may find that your journey with MS brings you into contact with a wide variety of health care professionals as you seek diagnosis, treatment and support for your condition. In general, you will start with a local, generalised service such as your GP, and be referred to specialists who may be situated further from you.
As MS is different for each person who has it, your journey may be unlike that of other people with MS. You may have referrals to more than one place to deal with different symptoms. You might find that keeping a record of your appointments, letters and other communication with health professionals helps you to keep track of your care.
In the NHS, health care is organised and funded by region. In England, care is administered by Clinical Commissioning Groups (CCGs), which replaced Primary Care Trusts (PCTs) in April 2013, or in some cases by NHS England. In Scotland, Wales and Northern Ireland, the equivalent organisations are called Health Boards.
Primary care refers to services that a person usually first sees when they have a health problem. For many people with MS this is often a GP or a practice nurse, though services such as pharmacists, NHS Direct, walk-in centres, opticians and dentists also fall under primary care. In the majority of cases, primary care services are based in the community at a range of settings, including GP practices, local health centres, community clinics or your own home.
Primary care is based on caring for the person rather than specific conditions, so professionals who work in primary care are generalists rather than specialists in any particular disease area. Primary care involves treating common illnesses, managing long term conditions and preventing future ill health through advice, immunisation and screening programmes. Primary care practitioners can also refer you on to more specialist services if needed.
If you have a condition that a primary care professional cannot resolve for you, they will refer you to a secondary care service. Secondary care refers to services provided by health professionals who generally do not have the first contact with a patient. So for MS, you may be referred to a neurologist or MS team at your local hospital.
Secondary care services are usually based in a hospital or clinic, though some services may be community based. They may include planned operations, specialist clinics such as cardiology or renal clinics, or rehabilitation services such as physiotherapy.
Tertiary care is healthcare provided in specialist centres. Consultants in tertiary care centres may have access to more specialised equipment and expertise for your condition. Referrals to tertiary services are usually made by your GP or the care professionals at your local hospital. You may find you have to travel some distance to reach a tertiary care centre.
The National Hospital for Neurology and Neurosurgery in London is an example of a tertiary care centre.