Improvement Programme - Implementing the Scottish Service Model for Chronic Pain
We expect the implementation of the Scottish Service Model for Chronic Pain will lead to the improvements which we all want to see and provide consistent, equitable chronic pain services across Scotland. Scottish Ministers have given their commitment to accelerating progress on the chronic pain improvement programme of work.
The Scottish Government has supported the programme through a range mechanisms including: the provision of clinical leadership; funding to support our third sector partners; funding for the production of campaigns to raise awareness of support provided in the community setting by pharmacies and third sector; and pump prime funding over two years for the establishment of Service Improvements Groups/Managed Clinical Networks, which alone will amount to just over £1.3m.
The Improvement Programme has been supported by Healthcare Improvement Scotland since 2009. During this time, working with the National Lead Clinician for Chronic Pain, a number of key achievements have been made including:
- development of the Scottish Service Model for Chronic Pain
- establishment of the National Chronic Pain Steering Group
- commitment from all boards to implement the model
- establishment of Service Improvement Groups / Managed Clinical Networks in every Board
- publication of SIGN Guideline 136 on the management of chronic pain
- launch of new Scottish chronic pain website
- establishment of a support network for NHS Chronic Pain Service Improvement Groups, to promote sharing of experience and best practice
- national community pharmacy campaign in January-February 2013
- national data collection exercise.
The National Chronic Pain Steering Group
The National Chronic Pain Steering Group has a remit to lead and oversee the improvement programme through the implementation of the Scottish Service Model for Chronic Pain. A number of sub-groups have been established to take forward work in specific areas:
- Learning & Development
- Children's Services
- Website & Editorial
- Primary Care
Most patients with chronic pain can be well managed in a community or local hospital setting by appropriately trained members of interdisciplinary local and specialist Pain Management Services.
Work has to date largely focused on developing chronic pain services in the secondary care setting. It is recognised, however, that ensuring early and appropriate management in the primary care/community setting is essential and will help to reduce both incidence of chronicity and inappropriate referrals to secondary care.
The recently published Scottish Intercollegiate Guidelines Network (SIGN) Guideline 136 on the management of chronic pain provides advice and recommendations on a range of interventions that may be considered within the primary care / community setting (such as supported self-management, physical therapies, exercise therapy, electrotherapy (e.g. TENS), acupuncture and pharmacological therapies).
The guideline also reviewed the evidence on the use of psychologically based interventions and recommends consideration of referral to a pain management programme, which can increase coping skills and improve quality of life. Outpatient Pain Management Programmes (PMPs) were established in six health board areas in 2013, a further two boards established PMPs in early 2014 and in three other boards have PMPs under development.
There is a great deal of work underway at a local level in each health board area and we are already seeing many examples of good practice. For example: development of a new electronic referral template from GPs to the secondary care service to improve the referral process; a pilot to test electronic direct referral from GPs to the Pain Association Scotland; various education programmes for primary care staff and multidisciplinary team members; establishment of new Pain Management Programmes.
Access to relevant information throughout the patient journey is a key part of supporting people living with chronic pain. Many Boards are developing information locally and the National Steering Group will encourage the development of consistent information which can be added to the newly refreshed national website. This website brings together quality assured information and resources for patients and healthcare professionals. Each Board has a dedicated page on the website to provide information about the services in place locally.
A new support network for the service improvement groups has been established to ensure that the learning and experiences from these projects and other examples of good practice can be shared across Scotland. A national event for the newly established support network was held by Healthcare Improvement Scotland on 20 March 2014, and we expect to hold further national events in the future. A series of WebEx meetings have also been held on a range of specific topics, including service user engagement, data collection, children's services and the chronic pain website, which have been a useful way of sharing experience virtually.
The research sub-group are considering future data collection, following the recent exercise conducted by HIS and exploring new methods for capturing information at a primary care level.
The key concerns highlighted in the consultation are around access to services and waiting times for those services. Addressing these issues is a central part of the work going forward. Boards are actively working to reduce waiting times, particularly for Pain Psychology services, and we have seen significant reduction in these waits in a number of areas. Boards have also made progress in addressing staffing vacancies and a number of staff members (including a clinical nurse specialist, psychologists and a physiotherapist) have recently been recruited. The Scottish Government and the National Chronic Pain Steering Group will continue to monitor progress closely.
The results of the recent data collection exercise will be provided in a report by HIS, this will provide boards with an up to date baseline from which progress can be measured.
To help drive forward service improvements all Boards are required to include improvement aims for chronic pain services in their Local Delivery Plans for 2014. Progress will be monitored by the Scottish Government through the Annual Review process. In addition, regular updates are provided to the National Chronic Pain Steering Group.
New Support Arrangements
HIS's specific role in the Improvement Programme concluded on 31 March 2014. New sustainable arrangements have now been put in place to ensure improvements are maintained and progressed. A new National Clinical lead and new Chair of the National Chronic Pain Steering Group have been appointed. In addition, a new National Co-ordinator has been appointed to provide support to the Steering Group as well as to local Service Improvement Groups/Managed Clinical Networks.
The key priorities for National Co-Ordinator and Clinical Lead will be working with the National Chronic Pain Steering Group and local service improvement leads network managers to:
- Embed new arrangements for monitoring to support the LDP process.
- Ensure the development of consistent referral criteria and care pathways and that these are shared and communicated widely through the support network and the national website.
- Work with SIGs/MCNs to encourage and support the management of chronic pain in the primary care community setting through the implementation of the SIGN Guideline 136.
The minutes of the meetings for the National Chronic Pain Steering Group along with progress updates will in future be published on the new national chronic pain website.
The Scottish Government is clear that equitable local chronic pain services should be in place across Scotland and through the work described above this will be achieved.