1. GP Guide Acute Back Pain pathway
AJ Welcome
This is the follow on session to the PLT that took lace in July, as a “taster” for the North East Acute back Pain pathway.
I am joined in the presentation by Diarmaid Ferguson-title, Phyio champion for the regional pathway and MSK physiotherapy practitioner Northumbria Trust
We also have in the room some of the other people supporting the regional project and also some of the practitioners working in the Virgin MSK service and CDDFT who will be the key individuals in supporting you and your patients
As I shared at the last PLT, this pathway has been developed on a regional basis, the rationale for being at scale, to avoid postcode lottery and variation in outcomes and to ensure the provision of NICE recommended CPPP element to the pathway that has up to now not been available as a therapeutic option.
The pathway and services to support has been implemented in the South Tees and HRW area in July this year and as part of the roll out we are incorporating the learning form these early sites. We are also very grateful for 2 of the Spinal practitioners for also joining us today.
Darlington and HAST are part of the next Phase and we go live with the pathway ?date December. As I mentioned previously this pathway has been supported in its early implementation by the NE AHSN and the roll out is being supported by the HF Scaling up Programme, who support a small number of projects nationally.

2. Back Pain and Radicular Pain Pathway v1.2

3. Back Pain and Radicular Pain GP Pathway v1.2

4. What’s in scope?
1st episode of acute back pain or a recurrence but has been pain free for preceding 6 months
Acute radiculopathy
What's Out of scope
Chronic back pain and acute exacerbations of ongoing back pain
Carl

5. Summary of Primary Care role
Screen for red flags
De-medicalise acute simple back pain by right messages from onset-all primary care team including receptionists
Promote self management with standardised information and advice
Sign-post the patient to self refer for physiotherapy assessment if still struggling with symptoms after 2weeks
Use the StarT Back tool at 2 weeks or 2nd attendance by GP
Do not refer for Xrays or MRIs unless red flags AJ

6. Red flags Trying to identify Central disc prolapse-cauda equina
Spinal tumours and metastases
Spinal infection
Osteoporotic fractures
Inflammatory disorders
Vascular pain AJ

7. Red flags- make you think!
H/O cancer
Recent unexplained weight loss
Progressive neurological symptoms, limb weakness
Bilateral leg sciatica
Positive Babinski ( upgoing plantars)
Altered perineal sensation with reduced anal tone and squeeze
Recent change in bladder/bowel control and or sexual function
Fever/patient feeling systemically unwell
Prolonged steroid use
Unrelieved, continuous night pain
New onset back pain < 16 and >60
Immunocompromised- steroids, diabetes, biologics and other immunosuppressants AJ

8. Second Presentation (1st presentation if had for 2/52 or more)
GP or Self referral physio appointment
Use 2nd page template
Repeat red flags assessment
If true radiculopathy and no improvement at review refer now to TTP
STarT back questionnaire completed
STarT scoring determines management
Patient information leaflet to be given
Obtain consent for patient contact details to be shared for the purposes of the survey AJ

9. Second Presentation continued
STaRT Back – quick 9 questions decision aid – on template
LOW RISK- 3 or less: no referral, be positive, reassure, continue activity, advise on return if concerns if worsens or goes on longer than 6/52
MEDIUM RISK-3+/9: refer routine TTP, but be positive they have still good chance of recovery naturally, continue encouraging movement, patient cancel appt if they do improve, otherwise if not they will be seen at 6/52 for TTP assessment with a view to appropriate therapy
HIGH RISK- 4+ High pysch score/9: Urgent referral TTP ( 2 weeks), Often psychological obstacles to recovery. Remain positive and challenge avoidance behaviour. if GP concerned request TTP contact patient by phone either on form or by GP contacting TTP by phone

10. Subsequent attendances
Ideally, the patient should not need to return to the GP, though may need fit notes if awaiting seeing TTP however, should the patient re-present, please use the 3rd page of the template title 3rd attendance/follow up so we can capture and quantify these attendances as part of the evaluation AJ

11. Timely return to work
Return to work is more than a goal; work is therapeutic and aids recovery, it restores physical and mental capacity and improves self esteem and confidence
Once a worker off for 4 – 12 weeks, have a 10%-40% risk of still being off work at one year. After 6 months of sickness from LBP, less than 50% chance of returning to their job
Try and encourage to remain at work unless impractical or unsafe to do so
RTW should be a major goal of rehabilitation (Hazard et al 1996)

12. GP Template Click below for EMIS WEB template Click below for SystmOne
VISION - COMING SOON

13. Evaluation of pathway
Consent for releasing contact details on template for 1st attendance or if late 1st presentation on 2nd page template
Inhealthcare will be collecting patient information as part of the evaluation process via an app that will be installed on each computer
Further details to follow….
This stage of the pathway rollout is subject to a robust evaluation process by Teesside University funded by the Health Foundation who are supporting the whole project. Learning the lessons whether we are successful or not. The patient and practitioner experience will be sought as part of this work. Those seen in MSK services will have their journey captured by the services they attend, however to get a population view we are trying to capture a proportion of everyone who attends in the 1st 7 days of symptoms anf then they will be approach if the consent, to being re-surveyed at 6 months. The output is only as good as the input. Please remember to ask the patient if they consent to a contact number or e mail being taken PURELY to inform them of what the survey will entail, usually on line and these numbers will be assimilated on a weekly basis from the practices. The patient will then on contact be in formed of what the survey will entail and they can agree or not to take it any further at this stage.

14. Resources/Help available
GP Template
Regional Back Pain website live from January
Your local TTPs!!
CSO’s within your practice
RBPP Project Team -