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BPS Pain Pathways

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BPS Pain Pathways Dr Andrew Nicolaou Consultant Pain Medicine St.George s Hospital, London – PowerPoint PPT presentation

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Title: BPS Pain Pathways


1
BPS Pain Pathways
  • Dr Andrew Nicolaou
  • Consultant Pain Medicine
  • St.Georges Hospital, London

2
Pain Patient Pathways Background
  • 2008 CMO report
  • - pain as a clinical priority
  • - consensus on best practice pathways
  • - improve HCP pain education
  • 2010 White Paper- Coalitions commissioning
    agenda
  • - unprecedented change
  • - do nothing was not an option
  • - meetings with BK, DoH, NICE, Commissioners

3
Pain Patient Pathways Trajectory
  • 2011-12
  • -5 BPS pathways developed by gt80 members
  • -Atlas of Variation
  • -Chronic pain proposed for NICE guidelines
  • and Quality Standard
  • -Pain Summit ( BPS, CPPC, FPM, RCGP, Patient
    organisations )

4
  • Strategy to preserve and improve pain medicine in
    the UK to benefit our patients
  • These endorsed pathways will provide the basis
    for
  • -Commissioning
  • -Teaching and training material

5
Pain Patient Pathways
  • Initial pain assessment and early management
  • Spinal Pain
  • Musculoskeletal Pain
  • ( non-inflammatory )
  • Neuropathic Pain
  • Pelvic Pain

6
Pain Patient Pathways
  • Current Status
  • All 5 pathways completed and submitted to MoM
  • MoM internal process negotiated
  • Evidence base re-reviewed
  • Independent scutiny
  • First 2 published 19/10/12
  • Final 3 published 19/11/12
  • Implementation and Dissemination the current
    phase

7
Initial assessment and management
  • Timely screening, assessment and management
  • Generalist, community / primary care perspective
  • Self-management resources
  • Risk stratification medium to high risk of
    disability
  • Support tools
  • Simple investigations to identify serious
    pathology

8
Spinal Pain
  • Risk stratification
  • STarTBack Tool from 2 weeks after onset of pain
  • Encouragement of self care
  • Fit-notes
  • Differing levels of psychological support
  • Timely access to specialist care when needed 3
    months or earlier radicular pain, 6 months or
    earlier for LBP
  • Interventional pain management
  • Strong Opioids

9
Chronic Widespread Pain
  • Support non-specialist care with a
    multidisciplinary approach
  • Identification of underlying diseases requiring
    treatment and patients with complex pain needs
    then early referral to appropriate specialised
    care.
  • Tramadol only opioid advised
  • Self management resources
  • Not medically unexplained symptoms

10
Neuropathic Pain
  • The pharmacological management of neuropathic
    pain in adults in non-specialist settings CG96
  • Assessment recommendations developed
  • Specialist setting pathways of care
  • Patient centered individualised care plans,
    self-help advice
  • Gabapentin included
  • Strong opioids specialist use
  • Specialist therapies SCS, drug infusions

11
Chronic Pelvic Pain
  • Non-specialist management
  • Role of secondary and tertiary care
  • Psychosocial, sexual, behavioural assessment /
    management
  • Multisystem disorders
  • Multidisciplinary pain management programmes
  • Specialist interventions

12
Strategy
  • Underpin
  • Commissioning
  • Training and Education
  • Quality agenda
  • - Quality standard NICE endorsement
  • Through
  • Implementation and Dissemination of the
  • Pain Patient Pathways

13
Implementation and Dissemination
  • 4 Workstreams
  • Patients BPS PLC with Anne Taylor,CPPC, Pain UK
  • Commissioners- Ollie Hart with RCGP
  • Primary /Community Care- Martin Johnson with RCGP
  • BPS membership- Nick Allcock
  • - link to Pain Summit workstreams, partner
    organisations e-learning for pain
  • - funding secured

14
Patient Workstream
  • PLC Chair appointed 11/2012
  • Patients involved in all workstreams
  • Patient information across a variety of formats
  • - Web-based, Apps
  • 15 things you would expect from your pain service
  • Business Cards, social media
  • Links into pathways from patient organisations
  • Patient scenarios
  • Illustrate pathways shared decision making
  • Publications

15
Commissioning
  • Develop consistent commissioning support
    materials
  • -Providers
  • toolkit for engagement / negotiation
  • language of commissioning
  • top-tips, differing levels of information
  • overview of process, likely scenarios / actual
    examples
  • -Commissioners
  • costings, value (gain to outcome)
  • Links to Pain Summit strategy 3, NICE
    endorsement

16
Primary and Community Care
  • Educational material
  • - with RCGP
  • ( embedded in Clinical Priority programme
    )
  • Commissioning materials
  • - workshops
  • Train the Trainer
  • Accreditation and training of GPwSI
  • Publications, e-guidelines, 10min consultation
    Handbooks

17
BPS membership
  • Disseminate pathways and commissioning materials
  • - Pain News and special edition
  • - Website, links, site for commissioning
    examples
  • - Membership email
  • Country/ regional workshops
  • - Primary and secondary care,
    Multiprofessional
  • FPM, Google-group, EFIC, IASP, SIP
  • Other publications / routes- BJA, Apps

18
Specific Projects
  • Country / regional workshops
  • - Scotland, Wales, NI, England x 6
  • ( London March 11th , ASM April, NoE May )
  • Assessment tools
  • - Relevant to QOF
  • Problematic Pain
  • NICE endorsement

19
Project Management
  • Executive Group
  • - Chair, 4x Workstream Leaders, Project
    Leaders,
  • President/President Elect, BPS Secretariat
    Manager
  • - Project Co-ordinator
  • Steering Group
  • -As above
  • -Partner Organisations ( FPM- Commissioning
    Beverley Collett, RCGP, CPPC )
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