1. Chronic Pain in Scotland: Just what have we achieved? Dr Lesley Holdsworth Dr Steve Gilbert

2. Purpose of This Session Share our story and key lessons learned; – Scottish Service Model for Chronic Pain – Our approach to implementation, the underpinning theory – The challenges and ways we’ve tried to overcome these What have we achieved?

4. Chronic Pain in Scotland What Pain that persist for more than 12 weeks despite treatment/medication When 2012-2014 2,300 800,000 Based on adult prevalence of 5.6%, CPG 4 Smith BH et al 2001

5. Treatment Guidelines

7. The ‘traditional’ chronic pain nightmare (pathway)

9. 1' representing no problem through to '5' representing the most severe category (All domains) 1 equates to ‘full health’ and death equates to 0 (EQ5D score). National median 0.3181 Normal population of same age = 0.80

10. Transformational Change the organisation and the vision NHS in Scotland the people who are part of that organisation Service users, the public, third sector, clinicians, managers: collectivism the services which the organisation delivers Chronic pain the processes which are involved in the delivery of the services Implementing the model for chronic pain Could we create the conditions?

11. Creating a ‘social movement’ – the WILL “a group of people with a common ideology who try together to achieve certain general goals ” oxford dictionary to successfully mobilize individuals, need an injustice frame - ideas and symbols that illustrate both how significant the problem is as well as what the movement can do to alleviate it

12. https://www.youtube.com/watch?v=V74AxCqOTvg

13. Our Approach: the IDEAS Create the conditions, drive & support the agenda Establish the vision, gain recognition – all levels Involve and empower stakeholders, the movement, Set a clear direction, expectations, what, by who and when Provide resources Enable and provide feedback Engender local ownership encourage the leadership of followers

14. The Chronic Pain ‘Execution’ Steering group – right membership, transparency Local groups a/a Government recognition, support & involvement Three agreed aims: 1. Develop a quality improvement infrastructure to support NHS Boards: key aims/plans, education, research, practice 2. Provide leadership, all levels and opportunity 3. Implement the model

16. National and Local Networks National and local learning days and other ongoing communications to: Create, share and nurture the vision Opportunity to contribute, to be part, to own the change, enthuse others Exposure to examples of best practice Head room to develop and plan local solutions Be involved in national work groups

17. Example 1: Level 1 Information/communication - Confusing landscape Variable quality of information for Service users The public Clinicians Local improvement groups Sub group – provided solution: with QA processes

18. @ www.chronicpainscotland.org @chronicpainscot

19. Example 2: Level 2 Some areas had programmes for upskilling GPs and AHPs including third sector Shared at national event Local interest generated Resources and experience shared Wider roll out – shared on website and primary care networks

20. Example 3: Level 3 Access and reducing waits Triage approach adopted in one area Experience shared at national meeting Other solutions being shared What users think of Level 3 services?

21. Patient Reported Experience Measure – Must do with me programme Involved Listened to Carers involved Information and advice Outcome of care Overall satisfaction

23. Example 4: Highly specialist services Issue: Variable referral rates of patients for interventions e.g. SPS Working group - all referral centres established National criteria agree Implemented Peer group

24. Service Users Politicians Third sector Service Managers Clinical teams Specialist Interest Groups Engaged and Proactive Just what have we achieved?

25. Transparent, local and national chronic pain improvement groups Plans with clear and transparent accountability Working groups, resources, communications and sharing networks National leadership, coordination Sustainability, but more work

26. Summary: Key learning Hearts and minds Creating the conditions for this to happen Collective will Sustainability

27. Leaders and critically, followers