The Centre for Active Lifestyle Management (CALM)

1. The Centre for Active Lifestyle Management (CALM) Dr Stephanie Jarrett Consultant Clinical Psychologist Pain Management Unit University Hospital Lewisham

2. Setting the scene • Chronic pain - British Pain Society definition: • “continuous, long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred after trauma or surgery” • Diagnoses: • Osteoarthritis • Degenerative changes/disease • Spondylosis • ‘Wear and Tear’ • Complex Regional Pain Syndrome • Fibromyalgia • Chronic widespread pain

3. Setting the scene People living with chronic pain: 7.8 million Prescriptions for pain: £584 million The cost to the NHS of chronic (long-term) back pain alone is estimated to be £12.3bn per year The management of chronic pain in primary care accounts for 4.6 million GP appointments, costing around £69 million per year Patients with chronic pain experiencing depression: 49%

4. Setting the scene • Comprehensive, multi-disciplinary group programme is the most efficacious and cost-effective treatment for patients with chronic pain (Gatchel & Okufuji, 2006; Guzmán et al 2001) • Multidisciplinary group pain management programmes (PMPs) are recommended for patients with chronic non-malignant pain by • The British Pain Society • European Guidelines • The International Association for the Study of Pain • Report by Dr Foster(2003) identified the patchy provision of PMPs in the UK.

5. Lack of PMPs in South-East London Northwick Park National Hillingdon Ealing INPUT Chelsea Wolfson Kingston COPE Epsom

6. Lack of PMPs in South-East London National Northwick Park Hillingdon National Ealing Hillingdon INPUT Ealing Chelsea INPUT Chelsea 15k Diameter CALM Wolfson Kingston Wolfson 20k diameter Kingston COPE COPE Epsom

7. Past: 2001 – Recruitment of Clinical Psychologist to Chronic Pain Service, University Hospital Lewisham 2002 – Pilot Programme 2004 – 1st Business plan put forward 2009 – Obtained 12 month funding 2010 – 6 month extension 2011 – 12 month extension until March 2012 2012 – Mainstream funding

8. Present: • The CALM team – • Consultant Clinical Psychologist • Clinical Physiotherapist Specialist • Pain Nurse Specialist • Psychology Assistant • Administrator • All 0.4 wte

9. The CALM Programme • The CALM programme aims to help patients: • Develop strategies to reduce the distress & disability caused by pain • Decrease reliance on medical professionals • Improve quality of life

10. Referral • Referrers - secondary care pain related services • Chronic Pain service • Rheumatology • Orthopaedics • Musculoskeletal assessment and triage (MSK) service • Physiotherapy • Referral process • Check patient is registered with Lewisham GP • Check patient eligible for CALM programme: • No ongoing litigation • No ongoing medical intervention (other than medication) • No ongoing investigations • No active psychosis • Discuss referral with patient • If patient in agreement – send referral letter to CALM team • Discharge patient to care of CALM team

11. Referral letter received Programme suitable - offered place Patient phones to arrange individual assessment Patient phones to arrange date for group information meeting Attends group information meeting. Invited to contact CALM team to arrange date for individual assessment Seen individually by psychologist, physiotherapist & nurse for assessment Patient sent letter inviting them to phone and arrange a date to attend a group information meeting about the CALM programme DNA group information meeting DNA assessment Programme not suitable – referred to more appropriate service No contact to arrange assessment appointment within 28 days No contact from patient within28 days Discharged – inform referrer and GP

12. Weekly group sessions for 10 weeks 6 months later – Second follow-up group session Assessment – offered place on programme 6 weeks later – First follow-up group session Open invitation to yearly ‘booster’ session

13. Outcome Data – Quality of Life • Distress • Depression (Beck Depression Inventory II) • Catastrophising (Pain Catastrophising Scale) • Fear of movement (Tampa Scale of Kinesiophobia) • Disability • Sit-to-stand (number per minute) • Pain interference (British Pain Inventory) • 96 patients reached 6 months follow-up • Complete data available for 90 patients • Bonferroni’s correction for multiple analyses p<0.008

14. Outcome Data – Quality of Life

15. Outcome Data – Health Care Use • Computerised appointment system • Secondary care pain-related appointments • Physiotherapy appointment s • Contacted GPs to get data on primary care pain-related appointments

16. Outcome Data – Health Care Use

17. Outcome Data – Health Care Costs • Clinical coding department to get accurate costs for: • Secondary care pain-related outpatient appointments • Physiotherapy appointments • Interventions (e.g. Epidural, trigger point injection etc.)

18. Outcome Data – Health Care Costs

19. Happily Ever After? Pilot phase ended and taken into mainstream funding in April 2012 But... Trust Special Administrator’s draft report “Securing Sustainable NHS Services” - Consultation on the future of South London Healthcare NHS Trust and the NHS in South East London (November 2012)

20. Thank you • The CALM Team • Sarah MacNeil – Clinical Physiotherapy Specialist • TamzinBunton– Pain Nurse Specialist • Ajay Clare – Psychology Assistant • Reuben Richards – Administrator • Lewisham support: • Dr Tom Smith – Consultant in Pain Management • Ashley O’Shaughnessy – Head of PBC and Services Redesign, NHS Lewisham • Lewisham Practice Based Commissioners • Hilary Rankin, Consultant Clinical Psychologist and her team at COPE, Sutton Hospital • INPUT