Transcranial Magnetic Stimulation (TMS) in the NHS

Approved by NICE since 2015
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TMS is still a relatively new treatment for depression in the UK, following NICE assessing the safety and efficacy of rTMS for depression in 2015. As a result, it is not widely offered by NHS trusts in England or elsewhere.

The Covid 19 pandemic has set back the development of NHS TMS services even further.

Why Should NHS Trusts Offer TMS?

  • TMS is a safe and effective treatment for depression which is approved by NICE and so there is an expectation that treatment will be accessible
  • TMS can be used as an alternative to ECT for certain patient groups with less risk of side effects and increased acceptance
  • Outcomes are favourable, particularly for the treatment resistant population (including patients resistant to ECT) and those who do not want to take anti-depressants
  • It offers a cost-effective treatment option for patient populations where other treatment options are more expensive, are less effective or have stronger side effects
  • TMS is not aerosol generating which is a positive consideration given the Covid pandemic

What is Required to Run a TMS Service?

To establish a TMS service, the following will be needed:

  • A TMS machine. These can be purchased from the manufacturer – there are four represented in the UK.  Prices and suitability for clinical practice vary widely, requiring careful research.
  • A consultant psychiatrist with training in TMS. The Royal College of Psychiatrists requires all TMS services to be led by a psychiatrist who is appropriately trained in TMS delivery.  The machine manufacturers offer training but it is usually limited in time and depth as they have limited experience in delivering TMS services.
  • A location for the machine from which to deliver the service. The physical requirements for the service are limited and a service is better delivered in an outpatient, clinical environment as opposed to inpatient, hospital setting.  Ideal is a clinic room of approx 150 sq ft.
  • A team of trained staff able to deliver TMS under the psychiatrist’s direction. TMS can be delivered by nurses, HCAs or AHPs, under the direction of the lead psychiatrist.  Training is required to ensure the service is safe and effective.
  • A funding model with the CCG.

How Smart TMS Can Help:

Smart TMS is the UK’s largest and most experienced provider of TMS.  We have established more TMS clinics than any other UK provider and are thus ideally placed to help NHS trusts establish TMS services.  We can provide the following advice to set up a service:

  • Advice on whether it makes sense to establish a service at all if patient numbers are low. It may be that outsourcing treatment is more appropriate
  • Developing a business plan for the new service
  • Which machine to buy, helping to navigate between the competing manufacturers
  • Training for the TMS lead and the team
  • Ongoing CPD in TMS
TMS savings

NHS Partnership Programme

Based on analysis originally developed with Northamptonshire NHS Foundation Trust, Smart TMS can save a typical Mental Health Trust around 45% of its annual expenditure on TMS patients.  The initial treatment has a pay-back period within the annual budget cycle.

Smart TMS has set up a Patient Partner Programme to treat an initial cohort of patients on a success basis, your Trust only pays for those patients that achieve remission.

If you would be interested to learn more, please submit your details here: