integrated pain and spinal service (ipass)
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Integrated Pain and Spinal Service (IPASS)
Innovative, integrated and collaborative approach to persistent pain management
Dr Rupert WoolleyGP, Clinical lead, North and West Reading, Clinical Commissioning Group
Dr Antoni ChanConsultant Rheumatologist and Associate Medical Director
Royal Berkshire NHS Foundation Trust
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Size of the Price
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Neck and Shoulder Pain
Rheumatology
Shoulder Clinic
Neurology
Spinal OrthopaedicMSK-CASGP
Pain Clinic
I was in extreme pain
I was told it was muscular
I have gone from one person to another
I thought it would have sorted out the problem
PhysiotherapistX 2 Osteopath
Acupuncturist
Massage Therapist
Lower Limb Team I was told it was mechanical
15 MonthsTime in
Circulation
X-raysMRICT
Bloods
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Working Together and Building Strong Partnerships
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Ideas creation
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Neck and Shoulder Pain
Rheumatology Shoulder ClinicNeurology
Spinal OrthopaedicMSK-CASGP
Pain ClinicWhat makes this the best
What is ideal
Who and what else needs to be in this pathway
Right place,Right person,Right time
PhysiotherapistX 2 Osteopath
Acupuncturist
Massage Therapist
Lower Limb Team Signposting and triage
Rapid Access
MDTApproach
Earlyintervention
IntegratedService
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Traditional Patient Pathway vs Integrated Pathway
Patient GP RBFT GP
7
Patient
GP
Community
Providers
Social Services
RBFT
Traditional Patient Pathway vs Integrated Pathway
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Our Local Area
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CSS to IPASS: A Patient’s Pathway• 33 year old lady, Episode of Lower Back Pain 4 weeks prior
GP
• Via DXS – self help resources
• Via simple one page referral to IPASS
IPASS
• Triage and treat function
• Explain/empower/enhance/engage
advanced
• Referred to surgeon for surgery if needed
• Referred to complex pain clinic if criteria met
Is usually completed within 6-12 weeks
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IPASS Spinal Pathway
via on call team
* see separate process map for IPASS - pain arm
GP medications
review/ Neuropathic
pain guidelines
Bloods
MRI
X-RAY
Talking therapies
Physiotherapy +/-
Acupuncture
Back Rehabilitation
GP
Community
Spinal Service
Assessment
Neurology
Rheumatology
T&O URGENT/
RED FLAGS
Mentoring
Community Spinal
Service
Follow-up
Nerve root
bock/Epidural
direct listing
Primary Care IPASS Spinal Secondary Care
IPASS Pain
Assessment *
self management
and D/C
Pain Clinic
Pain Service
Assessment
see
seperate
pathway
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IPASS Pain Pathway
* see separate process map for IPASS - spinal arm
Future services to be planned
Consultant MDT
clinic
1:1 Psych
IAPTS
1:2 Physio/Psych
assessment
One off education
1:1 Physio
Assessment 1:1 Psychology or
Pain physio
MSK
Physiotherapy
+/- Acupuncture
Investigations
GP
IPASS
Pain
Triage
Neurology
Rheumatology
Pain
Management
T&O
URGENT/
RED FLAGS
Dorset
mentoring
model
IPASS
review
Primary Care IPASS - Pain Arm Secondary Care
D/C
Guided self Help
(Pysch assist led 1-1
CBT)
Pain Programme
Level 2
Pain Programme
Fibromyalgia
ProgrammeSpinal
Service
Assessment
Back Rehabilitation
group
Case mentoring with
pain consultant
see Spinal
pathway
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Group Programmes
Pain Management Programme
Fibromyalgia Programme
Explain PainBack to Fitness
Bodyworks
IPASS
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IPASS Pain Outcomes
Outcomes for all patients in IPASS pain September 2016 to September 2017
0
5
10
15
20
25
30
35
40
Patient SelfEfficacy
Patient SelfEfficacy
Patient SpecificFunctional Scale
Paitent SpecificFunctional Scale
Flourishing scale Flourishing scale
Assessment
Discharge
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IPASS Financial Performance
No IPASSIPASS Year One
IPASS Year Two
Total Savings so far = £344,877
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Spreading Good Practice and Collaborative Working
• IPASS was introduced prior to November 2016 release of NG59 NICE Guidance for Lower Back Pain
• Disseminated through regional and national networks
• IPASS Toolkit (BSR)- used within other areas of the UK - a template for Berkshire West ICS
• System working prior to first wave ICS
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Challenges
• Short up and running time
• Recruiting adequately trained specialist staff
• Scheduling
• Space for staff
Benefits > Challenges
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The patient story
https://www.youtube.com/watch?v=TwaDCprvU2A
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H
H = Berkshire Health FT
= Royal Berkshire HFT
Key:
North and West Reading CCG:• GP practices = 10• Population in 2016/17 =
110,197
South Reading CCG:• GP practices = 20• Population in 2016/17 = 138,635
Wokingham CCG:• GP practices = 14• Population in
2016/17 = 161,251
Newbury and District CCG:• GP practices = 11• Population in 2016/17 =
118,043
H
H
Royal Berkshire HFT:Provider of acute services
Berkshire Health FT:Provider of mental health and community services
H
Geography and partner organisations
Berkshire West Integrated Care System (ICS)
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Thank you
Best Practice Award Winner