Greater Glasgow and Greater Glasgow and Clyde Managed Clyde Managed Clinical Network for Clinical Network for Chronic PainChronic PainDr. Colin P. RaeDr. Colin P. Rae

Consultant in Anaesthesia and Pain Consultant in Anaesthesia and Pain ManagementManagement

North Glasgow Pain ServiceNorth Glasgow Pain ServiceLead Clinician GG&C MCNLead Clinician GG&C MCN

Chronic PainChronic Pain

• Common problemCommon problem• Estimated prevalence 1 in 5 of Estimated prevalence 1 in 5 of

general populationgeneral population• Pain part of many different chronic Pain part of many different chronic

conditions/illnessesconditions/illnesses• Chronic pain often not recognised Chronic pain often not recognised

and difficult to manageand difficult to manage• Increasing incidenceIncreasing incidence• Big medical, social and political Big medical, social and political

cost cost

Chronic Pain Chronic Pain Management Service in Management Service in GG&CGG&C

• Small secondary care based service Small secondary care based service based at 3 sites in GG&Cbased at 3 sites in GG&C

• Consultant Anaesthetist/Pain specialist Consultant Anaesthetist/Pain specialist led with Multidisciplinary teamled with Multidisciplinary team

• Little awareness in primary and Little awareness in primary and secondary care of service or principles secondary care of service or principles of chronic pain managementof chronic pain management

• Historically under resourced and very Historically under resourced and very variable provision between sitesvariable provision between sites

GRIPs report July 2008GRIPs report July 2008

GRIPs report RecommendationsGRIPs report RecommendationsJuly 2008July 2008

Priority Action 1Priority Action 1

Scottish Government to designate chronic pain as Scottish Government to designate chronic pain as a condition in its own right, welcome the inclusion a condition in its own right, welcome the inclusion of chronic pain on the agenda of the Long Term of chronic pain on the agenda of the Long Term Conditions Alliance and support uptake of Conditions Alliance and support uptake of Managed Clinical Networks (MCN) in Chronic Managed Clinical Networks (MCN) in Chronic PainPain

GRIPs report RecommendationGRIPs report RecommendationJuly 2008July 2008

Priority Action 2Priority Action 2

NHS Boards to develop core secondary services, clear NHS Boards to develop core secondary services, clear referral pathways from primary care to secondary care referral pathways from primary care to secondary care chronic pain services, and for tertiary services such as chronic pain services, and for tertiary services such as Spinal Cord Stimulators (SCS), Intrathecal Drug Delivery Spinal Cord Stimulators (SCS), Intrathecal Drug Delivery (IDD) and Pain Management Programmes (PMP). These (IDD) and Pain Management Programmes (PMP). These should take into account the administrative reforms should take into account the administrative reforms recommended by the McEwen Report, Chronic Pain recommended by the McEwen Report, Chronic Pain Services in Scotland, 2004 and will support the Services in Scotland, 2004 and will support the development of chronic pain services at Managed Clinical development of chronic pain services at Managed Clinical Network and Community Health Partnership (CHP) levelNetwork and Community Health Partnership (CHP) level

What were the issues for the chronic What were the issues for the chronic pain service in GG&C?pain service in GG&C?

• How to reduce inequalities in service provisionHow to reduce inequalities in service provision• How best to provide pain management services in How best to provide pain management services in

secondary care?secondary care?• How to improve management in primary care?How to improve management in primary care?• How to improve ‘patient journey’and improve patient How to improve ‘patient journey’and improve patient

information information • How to improve communication and information?How to improve communication and information?

- primary and secondary care- primary and secondary care- patient and health care professionals- patient and health care professionals

• How to encourage and promote self management?How to encourage and promote self management?• How best to link with other existing servicesHow best to link with other existing services

Managed Clinical NetworksManaged Clinical Networks

• Streamlining patient journey and improving Streamlining patient journey and improving

quality of servicequality of service

• Making most effective use of resourcesMaking most effective use of resources

• Patient involvement / Multi-professionalPatient involvement / Multi-professional

• Planning forum Planning forum

• Education and trainingEducation and training

• Quality assurance programmeQuality assurance programme

• Annual report and work planAnnual report and work plan

Chronic Pain MCN Chronic Pain MCN StructureStructure

• Lead Clinician(s)Lead Clinician(s)• AdministratorAdministrator• Executive groupExecutive group• Steering GroupSteering Group• Standards sub groupStandards sub group• Pathways sub groupPathways sub group• Education sub groupEducation sub group• Audit and Research sub groupAudit and Research sub group• IT sub groupIT sub group

Other functions of the MCNOther functions of the MCN

• Representation on GG&C Long Term Representation on GG&C Long Term Conditions Group Conditions Group

• Learning from other MCNsLearning from other MCNs• Representation on Chronic Pain National Representation on Chronic Pain National

Steering group Steering group • Cross Party Working Group Cross Party Working Group • Involving clinicians, patients and third sector Involving clinicians, patients and third sector

groupsgroups• Area Drugs and Therapeutics committeeArea Drugs and Therapeutics committee• Examining inequalitiesExamining inequalities• IT developmentsIT developments

Chronic Pain MCN AchievementsChronic Pain MCN Achievements

• Primary Care guidelines developed and updatedPrimary Care guidelines developed and updated

• Standardisation of patient information and drug Standardisation of patient information and drug information information

• Development of regional chronic pain websiteDevelopment of regional chronic pain website

http://www.knowledge.scot.nhs.uk/pain.aspx

• Development of referral criteriaDevelopment of referral criteria

• Development of standards for chronic pain serviceDevelopment of standards for chronic pain service

Chronic Pain MCN AchievementsChronic Pain MCN Achievements

• Training needs assessment undertaken of primary care Training needs assessment undertaken of primary care professionals in GG&C and secondary care nurses and professionals in GG&C and secondary care nurses and physiotherapistsphysiotherapists

• Survey of needs of patients with chronic pain Survey of needs of patients with chronic pain

• Rolling education programme startedRolling education programme started

• Increased access to pain clinics for advice Increased access to pain clinics for advice

• Pilot of Specialist Nurse led local access chronic pain clinic Pilot of Specialist Nurse led local access chronic pain clinic in Paisley and Clydebankin Paisley and Clydebank

• Improving data collectionImproving data collection

Work in progressWork in progress

• Improving chronic pain management Improving chronic pain management pathways in primary carepathways in primary care

• Improving data collectionImproving data collection• Development of chronic pain management Development of chronic pain management

‘app’‘app’• Further development of chronic pain web siteFurther development of chronic pain web site• Development of elearning modulesDevelopment of elearning modules• Improving prescribing and monitoring of Improving prescribing and monitoring of

analgesic medications (opioids)analgesic medications (opioids)• Monitoring of quality of careMonitoring of quality of care• Examining health inequalitiesExamining health inequalities

Summary

GG&C MCN for chronic pain

- Cheap!- Good planning vehicle for service- Provides continuing focus for

improvement in service quality and efficiency

- Patient and third sector key involvement- Tangible achievements