Pain management service delivery framework: implementation plan update

Background

Chronic pain is pain that persists beyond normal injury healing time or recurs for longer than three months. It is a separate condition in its own right, and frequently presents alongside other long-term health conditions. Chronic pain can have a substantial impact on general health and wellbeing and is often described as a distressing experience.

Framework for Pain management Service Delivery

A Framework for Pain Management Service Delivery was developed across 2021 following consultation with the National Advisory Committee for Chronic Pain (NACCP), people with lived experience of the condition and other stakeholders.

The new framework sought to improve on the existing Scottish Service Model for Chronic Pain as people with Chronic Pain reported they still did not experience consistent, high-quality care when seeking support for their condition. The Framework set out, for the first time, a national vision to improve their wellbeing and quality of life. It serves to improve standards of care and support and to inspire innovation through four aims.

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Aim A - Person Centred Care: Community-based support, quality information, compassionate care.

Aim B - Accessible Care: Coordinated services, specialist support, more access options.

Aim C - Safe, effective support: Consistent care, safe use of medication, sustainable care.

Aim D - Improved services are care: Skilled healthcare, data-driven care, innovative care.

Aim A – Person Centred Care

We will improve the consistency and quality of the information and advice available to people with chronic pain, increase healthcare professionals’ understanding of the condition and its impact, and deliver better access to a range of local options to support self-management and wellbeing.

Aim B – Access to Care

We will enhance access to support for people with chronic pain by improving how local and national services are planned and delivered so people have a more consistent and better coordinated experience of care.

Aim C – Safe, effective support to live well with chronic pain.

We will improve the choice and care outcomes from pain management support available to people with chronic pain by evaluating and promoting sustainable delivery of effective and evidence-based care.

Aim D – Improving services and care.

We will invest in pain management services by improving workforce knowledge and skills, enhancing the use of data and research, and developing national standards to deliver more consistent care outcomes for people with chronic pain.

Framework for Pain management Service Delivery – Implementation Plan

The Implementation Plan published in July 2022 set out 18 initial actions to deliver the Framework with estimated timeframes for delivery. Good progress has been made against these actions and the Short Life Working Groups (SLWGs) and Pain Management Networks established to support implementation continue to evolve and develop the current actions, supported by a robust governance structure.

Our response to engagement on the Implementation plan

A commitment was made in the Implementation Plan to review the recommendations annually, through the governance structure and make further recommendations which would improve the lives of people living with chronic pain. This updated Implementation Plan sets out continuing and new actions and gives expected timescales for delivery.

We engaged with stakeholders regarding the first iteration of the Implementation Plan and suggestions for this update between May 2023 and August 2023. We facilitated engagement with key stakeholders and those with an interest in chronic pain to provide an opportunity to feedback directly to members of the Pain Management Task Force virtually or in writing or anonymously using a feedback form.

We are grateful for the time that respondents took to contribute and welcome their input towards shaping the new Implementation Plan.

There was a high level of support for the Aims and Commitments set out in the Framework for pain management service delivery: Implementation Plan. There was also challenging, and constructive feedback provided regarding the current content and the opportunities an updated Implementation Plan could address to improve the lives of people with chronic pain. From our engagement we heard that the updated plan had to be specific in its aims, have measurable outcomes and have timescales for delivery. In response we have set out clear actions, included how outcomes will be measured, and estimated timescales for delivery.

Respondents also highlighted a need for transparent leadership and a greater need for lived experience involvement in the delivery of the plan. The existing governance structure has been revised and outlines the clear lines of accountability to Scottish Government Ministers.

Progress on Actions

In the past year we have made significant progress against the initial 18 actions outlined in the Implementation Plan. A summary of our progress is given below, for a more detailed breakdown of progress please see the progress report published on our website.

Aim A – Person Centred Care

Establish a national expert working group to oversee co-ordination and development of chronic pain information and resources.

The group was established. The work of this group will continue in Action 1.

Establish a Chronic Pain knowledge hub for healthcare professionals to promote understanding and learning on chronic pain.

Expected launch in November. Work will continue in Action 2.

Develop a pain informed care toolkit for healthcare professional to promote care in all settings.

Levels 1 and 2 of the Knowledge and Skills Framework are currently undergoing evaluation. Work will continue in Action 3.

Enhance coordination of community and third-sector support for people with chronic pain.

A Third Sector Network was created and an agreed workplan was established. Work will continue in Action 4.

Aim B – Accessible Care

Identify local barriers, opportunities and priorities from users of chronic pain services.

Work was commissioned from HIS. Gathering views on chronic pain | HIS Engage to inform the delivery of the Implementation Plan.

Establish the NHS Pain Service Managers Network to improve co-ordination and planning of specialist pain services.

The group was established in October 2022. The work of this group will continue in Action 6.

Carry out a review of highly specialised pain services and enhance nationwide delivery of pain management programmes.

This action was completed through work carried out by NSD.

Deliver a new digital approach to improve the choice of people with chronic pain in how they engage with services.

Pilot completed in NHS Highland and work underway to implement throughout Scotland. Work on this action will continue in Action 7.

Convene a national expert working group to identify and scale up improved pain service planning and delivery. Work will be carried into Year 2 of the Implementation Plan in Action 8.

Aim C – Safe, Effective Support

Update clinical guidelines for management of chronic pain to deliver evidence based care and support.

National SIGN guidelines are currently being updated. Work will continue in Action 11.

Promote safer, more effective prescribing for people with chronic pain.

Polypharmacy guidelines are currently being updated to include chronic pain hot topics. Work will continue in Action 12.

Delivering a national approach to specialist interventions for chronic pain.

Scottish Health Technologies Group to agree to undertake review of pain injections to ensure evidence based safe, effective and equitable delivery across Scotland. Work will continue in Action 13.

Aim D – Improved Services and Care

Establish a national Multi-disciplinary Pain Education Group. The group was established and is actively carrying out work related to actions in this plan.

Deliver new pain management training pathways for specialist and non-specialist healthcare professionals.

Credentialing work ongoing. Work will continue in Action 15.

We will work with Public Health Scotland to improve how we capture and report national data on chronic pain.

A group has been set up with PHS, clinicians and Board analysts ongoing. Work will continue in Action 16.

We will gather data through the Scottish Health Survey to improve the planning and design of care and support for people with chronic pain.

Data has been captured and is due to reported in December. Work will continue in Action 17.

We will identify shared research priorities to enhance care and services.

Work will be carried into Year 2 of the Implementation Plan in Action 18.