Commissioning the Dorset Community Persistent Pain Management Service

1. Commissioning theDorset Community Persistent Pain Management Service Why is it so Painful to Commission Pain Services? 18th December 2012 Nichola Arathoon

2. Health Needs Assessment Prioritisation and Workplan Development The Commissioning Cycle Current Service Review Manage Quality and Outcomes Manage Performance and Demand Service Design and Planning Contracting & Implementation Securing the services

3. Background • Secondary care delivered injection based service in three acute providers • Long waits for repeat injections • Patient complaints • Press involvement • Board of Governors

4. Service Review • Service review Pan Dorset • Complaints • Pathway • Activity • Capacity • Funding

5. Service Redesign • Best practice research • Interventional Procedures in the Management of Spinal Pain Policy • Multidisciplinary team triage of new patient referrals • Post injection patient diary • Increased funding for backlog patients on to new pathway

6. Service Redesign • Service Specification for bio psychosocial model of pain management • Dorset Clinical Commissioning Group • MSK Clinical commissioning Programme • Dorset Pain Society • Patient and carer involvement • Secondary care involvement • Primary care involvement • Education

7. Dorset Community Persistent Pain Management Service ETHOS: To enable adults living with persistent pain (of at least 3 months duration with a definitive diagnosis, including Medically Unexplained Symptoms, and/or when the patient and GP agree and accept that the pain has become chronic) to understand and come to terms with their pain and to adopt strategies for living, which allow them to lead as fulfilling and independent lives as possible.

8. Dorset Community Persistent Pain Management Service To encompass: Primary care education The provision of supported self-care and optimised medical therapy delivery in Primary Care at the onset of pain and appropriate onward referral to the Community Pain Management Service The clinical service The provision of enhanced pain management treatments and strategies

9. Primary Care Education • To support GPs in enabling their patients to live with persistent pain • To work with and educate GPs to safely optimise the use of analgesia • To educate GPs in the benefits of self management tools and techniques including motivational interviewing, the Expert Patient Programme and the Pain toolkit • To identify and work with GPs with a Special Interest in persistent pain management • To refer patients to the community persistent pain management service in a timely manner

10. The Clinical Service • Community based • Locality provided • Single point of access • Multidisciplinary pain specialist team: Physiotherapist, Occupational therapist, Psychologist, Doctor and Nurse • Interdisciplinary working with Secondary Care clinicians, community health services, medicines management teams, community mental health teams, substance misuse teams, community matrons, return to work services and voluntary agencies

11. The Clinical Service • Triage of referral form • Individual assessment and screening in to appropriate support/treatment • Personal care plan with goal setting and review with key worker • Provision of cognitive and behavioural therapies with psychological support • 1:1 and/or group pain management – health professional or peer led • Interventional therapy

12. Peer Support • Within groups • Pain Chain/buddy • Telephone help line • Dorset Pain Society • Peer led pain management courses

13. Lessons learned • Stakeholder engagement • Secondary care clinicians and managers • Primary care clinicians • Patients and public • Communication strategy • Current providers • Current patients • Media • Information and activity • From current service in to new service

14. The Commissioning Cycle

15. Thank You Any questions? Nichola.Arathoon@dorset-pct.nhs.uk