1. Welsh Backs GP engagement
Thank you. Good morning ladies and gentlemen. The focus of my presentation this morning the process of engaging GPs in the Welsh Backs campaign. However, before describing this process I thought that it may be helpful just to mention a little about the Campaign itself

2. Welsh Backs Campaign AIM
To minimise the financial, personal, and psychosocial effects of mechanical low back pain in Wales by promoting the ‘stay active’ message
Welsh Backs campaign aims to promote the ‘stay active’ message through effective engagement with

3. Information and support
Public
Multi - media campaign
Website
Patient information leaflets
Employers
Health and Safety Executive
Health professionals
Resources to support patient management
The public, employers and health professionals. The NPHS has been given the lead in engaging health professionals – particularly focusing on GPs and it is this process of engagement that I am going to describe this morning.
Before doing so I would just like to highlight the importance of working at the primary care interface in relation to meeting the aims of the Welsh Backs campaign

4. Importance of primary care interface
Effective healthcare
Improved health outcomes
Appropriate use of scarce NHS resources
Fitness for work
Appropriate advice
Health and well being
Demedicalisation
Empowerment
We know that at any one point in time 40% of individuals with low back pain will seek advice from a GP. However, in terms of the population impact of low back pain this has a disproprortionate impact.
Firstly this is how patients access NHS care – ensuring that they receive effective evidence based management not only improves health outcomes, but ensures appropriate use of scarce NHS resources. We need to ensure that GPs are aware of appropriate management and have the tools to support them in caring for patients appropriately
Then of particular relevance to this event today, it is at this point that patients obtain advice regarding fitness for work and if, deemed unfit, access the benefits system via this route. Again, GP education and appropriate resources are vital to ensure patients are given correct advice.
Finally, and of tremendous importance when considering health and well being of the population, it is at this interface that the is the re potential for directing patients away from the traditional medical model of care and to look outside the health service for the answer to their problems – demedicalising and empowering patients to self manage and take control of their health.
The back pain is a common problem which creates a huge public health burden yet we know that 95% of cases that occur in the working age population are due to mechanical low back pain

5. Effective healthcare Triage Activity Therapy Exclude serious pathology
Encourage normal activity – ‘Stay active’
Educate – ‘pain doesn’t mean harm’
Therapy
Analgesia
Refer for physical therapy if pain not settling
And that appropriate management is, in effect, to promote the stay active message.
Although this information is not new, the problem of inappropriate orthopaedic referrals continues as does sickness absence due to back pain. Hence the challenge in GP engagement to reorientate thinking towards self management, demedicalisation agenda to prevent back pain causing disability both at individual and population levels.

6. Engagement tools Free copies of the Back Book Educational resources
Signposting documents
So, building on this sound evidence base, what has been our strategy for engaging GPs across Wales. The emphasis has been on providing primary care professionals with tools to help them in managing patients with back pain – rather then telling them how they should be managing patients or adding work.
The starting point has been the provision of free copies of the Back Book by Welsh Assembly Government. This is a patient educational booklet, which was originally produced for use with Royal College of GP guidelines for the management of acute low back pain. Improved outcomes associated with its use have been demonstrated in one randomised controlled trial and experts continue to recommend it. To support the appropriate use of the Back Book within the GP consultation we have coordinated the production of a number of educational resources highlighting the evidence based approach to the management of acute low back pain. Then, finally, to support the demedicalisation agenda and to provide GPs with local information on local healthy living initiatives and resources to address occupational health issues we are coordinating the production of local signposting documents by working with the 22 local public health teams.
Key features of these tools are that they should be user friendly, simple, available in paper and electronic form.

7. Effective dissemination
Early adopters
Back book sent to all GPs in Wales
Letter / with links to on-line order form
Engaged GPs / pharmacists
CPD package
Audit tool
Primary healthcare professionals
Local CPD events
Interface with practices – promote resources
And now to our strategy for dissemination. It is well established that there are no ‘magic bullets’ for effective GP engagement and that a multifaceted approach must be adopted. Understanding this, we have undertaken a phased approach which builds awareness through multiple connections and hopefully, will embed the Welsh Backs message into primary care right across Wales.
We started by introducing the campaign to all GPs across Wales by sending out a copy of the back book and links to an online order form to allow any who were interested to order more copies. We then worked with a well respected and well know organisation to facilitate the production of a CPD package which was sent to all GPs and pharmacists in Wales and invited voluntary participation. Finally, we are currently working on organising more direct contact with GPS through local CPD sessions and facilitating the promotion of the resources through direct or indirect interface with individual practices.

8. Key partners Deanery Welsh Medicines Resource Centre
Organisational Effectiveness Programme
Welsh Medicines Resource Centre
Module on acute low back pain
Primary Care Quality and Information Team
Audit tool
Blaenau Gwent Local Public Health Team
Pilot of signposting document
Clearly this has been a collaborative effort involving a number of key organisations. The Post graduate deanery coordinates the appraisal system for all GPs in Wales. Appraisal is a necessary prerequisite to practice and therefore the deanery has contact details for all practicing GPs in Wales. I was enormously priviledged to be part of the Organisational Effectiveness Programme - a project based leadership programme organised by the Deanery. Welsh Back has been my project and, as a result, the Deanery facilitated the original cascade and continue to provide Welsh Backs updates in the quarterly appraisal newsletter. The Welsh Medicines Resource Centre which is well known and used by GPs as producing, among other things, on line and paper based CPD packages worked with us to produce a module on acute low back pain which was also sent to pharmacists across Wales for the first time. This is being supported by an audit tool produced by the PCQIT. This has recently been circulated to all GPs. Finally the concept of the signposting document has been taken forward by Blaenau Gwent Local Public Health Team who organised a workshop in CPD session with GPs to which representatives of various organisations - including job centre plus, condition management programme, expert patient, ex on referral and several others to discuss interface issues and way that they may work more effectively together. We are hoping to develop this model in other GP CPD sessions.

9. Progress to date 26,200 back books distributed Majority to GPs
Initial mailing – one to each GP – Nov 2007
Second copy sent with WeMeReC bulletin – March 2008
69.4% practices have requested further copies
So far 66.5% of all practices in Wales have requested further copies of the back book

10. Percentage of GP practices in each LHB which have requested ‘The Back Book’ up until September 2008
Local Health Board

11. Number of requests for ‘The Back Book’ between 19th November 2007 and 12th October 2008
Letter and to GPs
to practice managers via LHB
to practice managers via LHB
Evaluation questionnaire sent to all GPs

12. WeMeReC bulletin Case studies sent to 2,470 GPs
2,900 pharmacists (first time participated)
Completed by
688 GPs (28%)
247 paper copy and 441 on line
103 pharmacists
Bulletin and copy of back book sent to
2,470 GPs / 2,900 pharmacists
The WeMeReC module has been really successful with 28% of all GPs participating in the full module. It is likely that many more will have read the educational bulletin, but not completed the case studies to complete the module.

13. GP responses to survey question “How well equipped do you feel you are to …”
(from 200 of 688 responses to educational module on acute low back pain, 2008)

14. Ongoing work Production of signposting documents
Local Public Health Teams
Engaging with GP networks
CPD and appraisal coordinators
Engaging with LHB heads of pharmacy
Work with individual practices
Engaging with Trusts
Physiotherapy departments
Care pathways / Map of Medicine
Our final and, perhaps most challenging phase, is to make direct contact with GPs in order to introduce the resources available to them to manage back pain effectively. This involves liaising with all local public health teams across Wales to produce the signposting documents and then connecting into GP networks to facilitate direct contact with GPs. There are many such networks mainly working under the Deanery, but there are also practices taking medical students, sessional GPs and GPs working in Out of Hours services. We are also working with LHB pharmacy teams in order the facilitate the promotion of Welsh Back Resources at practice visits if analgesic prescibing is discussed. Finally we will need to engage with Trusts across Wales to ensure that Welsh Backs is firmly embedded in care pathways for the management of back pain. A link to Welsh Backs has been included in the Map of Medicine

15. Conclusion Coordinated approach Collaboration Created networks
Consistent messages
Public and professional
Collaboration
Potential for further GP engagement
Created networks
Potential for further public health programmes (smoking cessation)
The key features of this process are the coordinated approach and collaborative working across may different agencies. This has created networks through which the Healthy Working Wales Website will be disseminated. In addition, it demonstrates a model for delivering a public health programme through primary care – nationally coordinated and locally delivered. There is the potential to build on this model as we all work to promote the health of the population of Wales.

16. With special thanks to:
Nicola John, Local Public Health Director for RCT and Merthyr Tydfil
Leonie Roberts, Speciality Registrar in Public Health
Wendy Bowler, Principal Health Promotion Practitioner
Katrina Minton, Welsh Backs Project Co-ordinator
Alexia Saunders, PA to Dr Sally Venn

17. Thank you

18. For further information
Dr Sally Venn, Primary Medical Care adviser T: E:
Katrina Minton, Welsh Backs Project
Co-ordinator T: E: