1. Chronic Pain Services -The East Kent Model
Hilary Birrell
Community Chronic Pain and Orthopaedic Services - Service Manager

2. 3 Main Acute Hospitals 15 Community locations
Demographics
Population 750, GP practices
3 Main Acute Hospitals Community locations

3. Strategic Background
2005- Commissioners asked for review of MSK and pain service in East Kent in response to 18 week RTT and MSK NSF
Issues identified long waiting times; low D/C rates; ? outcomes; inequity geographically;
Community Pain Service started
Very successful, good outcomes, high patient satisfaction
Recognised nationally as an innovative community model
However………..

4. OPERATIONAL MODEL ISSUES
Community service was isolated in the health economy
2 separate pain services – hospital and community
Duplicate referrals to both services and occasionally orthopaedics or rheumatology as well
42% of referrals to community service came from hospital service (multiple first assessments)
Changes in other services – particularly orthopaedics increased need for pain services.
Difficult to manage patients’ and referrers’ expectations and educational needs.
So a new model that brought the hospital and community services together was successfully piloted and then adopted permanently.

5. East Kent Chronic Pain Services
SERVICE REMITS
The Hospital Pain service specialises in an interventional approach, and patients whose care is inextricably linked with other hospital services.
The Community Chronic Pain Service provides a conservative, long term, self management approach.
Support referrers with help and advice / telephone and education.
TRIAGE
All new referrals are paper triaged by either senior community clinicians or hospital anaesthetists on a rota basis
Agreed referral criteria and service remits inform triage guidelines
Collaboration and excellent communication are essential

6. Referral Criteria Pain for 6 months or more
Has definitive diagnosis or been fully investigated to rule out untoward pathology
Consideration for interventional pain procedure or previous successful pain intervention
No concurrent planned surgery / other interventions
Completed active rehabilitation
No untreated / unstable mental health problems
No current substance misuse

7. ONE ACCESS POINT Referral Point Model Completed referral received
Chronic Pain Referral Point – EK
Triage outcome actioned
sent electronically for clinical triage
Community Chronic Pain
Secondary
Care
Other
services
Reject to referrer
Choice
48 hrs
48 Hrs

8. Allocated to Community service
Full assessment & management plan
GPwSI or Consultant Nurse
Secondary Care
Intervention
Majority of patients attend ½ day
pain education session
CNS Clinic
Tens review
Med review
Healthy lifestyle management
Discharge planning
Tai Chi
PMP – face to face or on-line
Acupuncture
Psychology
1 to 1
Alexander Technique
Discharge
Long self management plan.
Support groups / EPP
Secondary care Intervention
Patient initiated re-access

9. Managing patient expectations Pathway review Productivity
Future
Geographic expansion
Managing patient expectations
Pathway review
Productivity
Service Outcomes
Audit
Support groups
Finance
GP education

10. ANY QUESTIONS?