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?