Chronic Pain Services -The East Kent Model

Hilary BirrellCommunity Chronic Pain and Orthopaedic Services -

Service Manager

Population 750,000 115 GP practices

3 Main Acute Hospitals 15 Community locations

Strategic Background

• 2005- Commissioners asked for review of MSK and pain service in East Kent in response to 18 week RTT and MSK NSF

• Issues identified long waiting times; low D/C rates; ? outcomes; inequity geographically;

• 2006- 2007 Community Pain Service started

• Very successful, good outcomes, high patient satisfaction

• Recognised nationally as an innovative community model

• However………..

OPERATIONAL MODEL ISSUES

• Community service was isolated in the health economy• 2 separate pain services – hospital and community• Duplicate referrals to both services and occasionally

orthopaedics or rheumatology as well• 42% of referrals to community service came from

hospital service (multiple first assessments)• Changes in other services – particularly orthopaedics

increased need for pain services.• Difficult to manage patients’ and referrers’ expectations

and educational needs.• So a new model that brought the hospital and community

services together was successfully piloted and then adopted permanently.

East Kent Chronic Pain ServicesSERVICE REMITS

• The Hospital Pain service specialises in an interventional approach, and patients whose care is inextricably linked with other hospital services.

• The Community Chronic Pain Service provides a conservative, long term, self management approach.

• Support referrers with help and advice email / telephone and education.

TRIAGE

• All new referrals are paper triaged by either senior community clinicians or hospital anaesthetists on a rota basis

• Agreed referral criteria and service remits inform triage guidelines• Collaboration and excellent communication are essential

Referral Criteria

• Pain for 6 months or more• Has definitive diagnosis or been fully investigated to rule

out untoward pathology• Consideration for interventional pain procedure or previous

successful pain intervention• No concurrent planned surgery / other interventions • Completed active rehabilitation• No untreated / unstable mental health problems• No current substance misuse

ONE ACCESS POINT

Referral Point Model

Completed referral received

Chronic Pain Referral Point – EK

Triage outcome actioned

sent electronically for clinical triage

Community Chronic

Pain

Secondary Care

Other services

Reject to referrer

Choice

48 hrs

48 Hrs

Majority of patients attend ½ day pain education session

Tai Chi

Acupuncture

Psychology1 to 1

CNS ClinicTens reviewMed review

Healthy lifestyle managementDischarge planning

Discharge Long self management plan.

Support groups / EPP

Patient initiated re-accessSecondary care

Intervention

Secondary CareIntervention

Full assessment & management plan

GPwSI or Consultant Nurse

Allocated to Community service

PMP – face to face or on-line

Alexander Technique

Future

• Geographic expansion• Managing patient expectations • Pathway review• Productivity• Service Outcomes• Audit • Support groups • Finance • GP education

ANY QUESTIONS?