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Chronic Pain Services -The East Kent Model

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1 Chronic Pain Services -The East Kent Model
Hilary Birrell Community Chronic Pain and Orthopaedic Services - Service Manager

2 3 Main Acute Hospitals 15 Community locations
Demographics Population 750, GP practices 3 Main Acute Hospitals Community locations

3 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; Community Pain Service started Very successful, good outcomes, high patient satisfaction Recognised nationally as an innovative community model However………..

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.

5 East Kent Chronic Pain Services
SERVICE 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 / 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

6 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

7 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

8 Allocated to Community service
Full assessment & management plan GPwSI or Consultant Nurse Secondary Care Intervention Majority of patients attend ½ day pain education session CNS Clinic Tens review Med review Healthy lifestyle management Discharge planning Tai Chi PMP – face to face or on-line Acupuncture Psychology 1 to 1 Alexander Technique Discharge Long self management plan. Support groups / EPP Secondary care Intervention Patient initiated re-access

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


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