Launch of Chronic Pain Pilot Project in N Somerset January 2025 update
North Somerset Pilot Project using the CPM Tool
This locality was selected because there are very large numbers of people receiving dependence forming medication for chronic pain in the practices (particularly in Weston Super Mare). These numbers are high for a range of drugs when compared with other practices in the local Integrated Care Board and also in England.
We started the project by studying the practice data trends, collecting practice questionnaires and carrying out discussions with stakeholders locally
Using the groupings of factors in the model, and the results from above we created a situational analysis for the practices in Weston (covered by Pier Health PCN) (Spring and Summer of 2024)
These are SOME of the findings from the situational analysis
- Access to specialist advice and services has not been available locally (patients have to travel to Bristol).
- The population is deprived, elderly, high levels of back pain, musculoskeletal problems and long-term conditions.
- The practice workforce has suffered from a lack of continuity, high level of GP locums and low levels of staffing. GPs report not having time to adequately treat Chronic Pain (CP) patients.
- Practice staff do not necessarily know what is available locally. Utilisation of other ways to manage chronic pain and teach and support people to live with it are not well organised in North Somerset.
- Prescribing is high (top two quintiles) in many practices compared to practices in BNSSG & England. Some reduction in opioids that have been targeted nationally, but others have increased over time
- Prescribing of alternatives such as gabapentinoids, tricyclic antidepressants, SSRIs and SNRIs, anxiolytics and NSAIDs indicates that these are being used extensively by practices in the locality compared to practices in BNSSG and England
- Current access to CP specialists is difficult with long waiting times and often patients must travel to Bristol
- There is a lack of specialist support to better manage patients with chronic pain
- There are long waiting times for orthopaedic procedures and other specialist services
- There are number of NHS personnel who are available to provide support to patients with CP – Health and wellbeing coaches, social prescribers, psychologists, physiotherapists.
- There are several local projects with groups (integrated care partnerships for example) to support people but not necessarily identified as for people with chronic pain
- There is a consultant in chronic pain who works in Weston Hospital who is keen to work with the practices to help support them to better manage their patients
- There is a substance addiction specialist nurse keen to provide support to help deprescribing
We are working with the practices to create an action plan for the PCN and are in the process of agreeing individual practice action plans
There are 5 main themes of the action plan that has been created
Service transformation – creation of a community chronic pain service
Support and education for primary care clinical staff
Joint working across primary and secondary care/ involvement of voluntary sector and local authority groups
Patient involvement and feedback
Reducing inappropriate prescribing (for current patient via deprescribing and preventing new patients being started on inappropriate medication
Examples of these are:
Service transformation
- This is fundamental to changing the way that chronic pain is managed. There are options in place but will need to be pieced together to create a Weston community chronic pain service. This is now in the process of being created.
- A local care pathway signposting the options available is needed for all practices so they know how best to manage patients. This will be created in the next few months.
- There are 6 social prescribers employed by the PCN and they have been identified as the ideal people to identify needs and manage the care of patients referred for alternative ways to cope with their chronic pain.
Support and education
- Training of social prescribers, and practice staff in how to best manage patients is essential. A local education programme “ Live Well with Pain” is going to provide training. Several staff in the locality have already attended this course since the start of this project.
Joint working
- Better relationships with secondary care are essential and the local consultant is keen to work with practice staff
- A chronic pain forum has been set up for all stakeholders in North Somerset (including voluntary groups and other sectors/private organisations who are interested in the project (2 meetings have taken place so far)
- To support management in primary care the consultant is running a regular multidisciplinary case study for the practices to discuss complex cases. This will also improve understanding of the aims of CP management amongst clinical staff in practices.
Patient involvement
- Patient involvement will be encouraged and sought as we set up the community pain service and widen deprescribing projects.
Reducing inappropriate prescribing
Deprescribing policies and initiation policies are being created and adopted.
Possible ideas for deprescribing
- Contact all CP patients to identify those keen to reduce medication as initial focus
- Group sessions in community to support deprescribing
- Regular phone calls for patients newly prescribed to encourage reduction in medication
- Patient led support for deprescribing and patients with CP
Evaluation and monitoring
Prescribing rates of all opioids and dependence forming drugs are being monitored monthly. Practice staff and patient questionnaires will be sent out in 2025 to evaluate the effect of the changes. Impact on practice appointments and referrals to the speciaist chronic pain service in Weston will be quantified. A case study is planned.
Launch of Public-Private Partnership Toolkit
Description of Toolkit
The hybrid nature of PPPs makes them more complicated and under-researched than partnerships involving only public organisations or only private companies. PhD research reviewed the previous literature/theory, researched a series of case study partnerships across the country and developed a new framework to help understand these issues. It draws on elements of the Partnership Assessment Tool (‘PAT’) (Hardy et al., 2003) which has been extensively used in partnership research and has been independently verified as a usefulway of assessing the strengths and limitations of relationships within a partnership (Petch, 2008). This toolkit takes the PAT questions and uses the boundary wall framework developed from thePhD research to focus in particular on the role of boundary spanners within PPPs (i.e. how easy or otherwise it is to work across agency boundaries depends on the nature of the differences/divisions between partners – these are described in terms of a ‘wall’ and potential differences are explored in terms of the ‘height’, ‘density’ and ‘thickness’ of the wall, as well as the foundations on which the wall is built).
How can the Toolkit help you?
It provides material for a ‘diagnostic phase’(using tools tested during the PhD research to provide practical support to the development of the partnership). This will identify key barriers/success factors that need to be worked with for the partnership to be successful. It provides material to construct an Organisational Development (OD) plan for the partnership.
For more details contact duncan@helpinghealth.co.uk or click on: