Pain management - service delivery framework: implementation plan

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 they have a more consistent and better coordinated experience of care.

You told us

Responses highlighted the challenges people with chronic pain face in accessing support and the impact this has, not only on their wellbeing, but also in some cases on the opportunity for earlier, more effective intervention. It was also suggested that in primary care settings there are challenges around resourcing and healthcare professional knowledge. Feedback was provided on the opportunities to leverage the skills and knowledge of other health and care professional roles and the importance of their closer integration in chronic pain care planning.

It was clear that waiting times for appointments and treatment have a significant impact on people's experience of their care and services. Respondents also shared the impact of poor communication between different services involved in their care, and with patients themselves. Feedback was provided on opportunities to improve referral and planning of care across different settings, as well as suggestions for what services should be accessible for everyone with chronic pain to help them maintain their quality of life.

In relation to digital technology, respondents highlighted some of the challenges around remote technology and concerns were raised around the risk of increased inequalities. Suggestions were made about the potential for digital education, improvement in access and examples of existing initiatives to test new approaches to delivering care.

What we will do

Improved planning and delivery of local services and support

Action 6: Convene a national expert working group to identify and scale-up improved pain service planning and delivery

It is accepted that demographic and geographic differences across the country inform how local services are delivered. However, a priority of this Framework is to ensure action is taken to reduce the unwarranted variation in experience and care faced by people with chronic pain. We will establish a SLWG to provide leadership to overs and drive delivery of this Aim.

This group is expected to scrutinise differences in provision of local NHS and care services used by people with chronic pain to identify areas of best practice and opportunities for improvement. They will also examine how the Scottish Service Model for Chronic Pain is currently being delivered across Health Boards to better understand the challenges and opportunities for service planning. They will also review previous work to improve the interface between community, primary and secondary care services, and identify opportunities for further tests of change and/ or scale-up of effective local pathways. This group will also make recommendations for increased collaboration across local, regional and national collaborative service planning, with the aim of improving the use of resources across clinical pathways and enhancing the sustainability of pain services and support at all levels.

Action 7: Identify local barriers, opportunities and priorities from users of chronic pain services

We will commission Healthcare Improvement Scotland (HIS) to deliver a Gathering Views exercise to identify opportunities and barriers to local implementation of the Framework. Information on the local barriers, opportunities and patient priorities will be used to inform and shape the activity of the working group. This will help to ensure that the group's outputs or recommendations for local service planning and delivery meet the needs of people with chronic pain. More information on this Action as part of wider Governance of the Framework is available on p.23.

Improved access to specialist pain management support

Action 8: Establish the NHS pain service managers network to improve coordination and planning of specialist pain services

There is further opportunity to improve coordination of care for people referred to specialist chronic pain services, especially as they continue to recover from the impact of the COVID-19 pandemic. We will establish a new Service Manager Network to promote shared planning and service development across Health Boards, with a focus on opportunities to address key shared issues, including resourcing, waiting times and financial challenges.

This Network will also engage with the working group for this Aim in order to ensure there is greater synergy and coordination between primary, community and specialist services. The Network forum will also enable a stronger national dialogue between local specialist services and the Scottish Government in order to ensure a more rapid, supportive and collaborative response to the challenges of pain management service delivery.

Action 9: Carry out a review of highly specialised pain services and enhance nationwide delivery of pain management programmes

The Scottish National Residential Pain Management Programme (SNRPMP), hosted by NHS Greater Glasgow and Clyde, accepts referrals from all Scottish Health Boards and provides highly specialised support for people with chronic pain. We will work with the National Services Division (NSD) of NHS National Service Scotland (NSS) who commission and performance manage national specialist services on behalf of NHS Scotland, to carry out a review of the service in light of changes to how the Programme was delivered during the COVID-19 pandemic.

The review is expected to identify opportunities to evolve the service and harness its expertise and skills to enhance service delivery and promote best practice of pain management programmes and supported self-management as a core element of clinical practice. This will provide a more consistent and higher quality experience of care for people with chronic pain.

Improve access and flexibility of pain services

Action 10: Deliver a new digital approach to improve the choice of people with chronic pain in how they engage with services

Remote Health Pathways use digital monitoring technology to enable people to receive, record and share relevant information about their current health and wellbeing with public services. In partnership with the Scottish Government's Technology Enabled Care (TEC) Programme, people with chronic pain and local Health Boards, we will deliver, pilot and evaluate a new 'digital pathway' to enable people with chronic pain to use technology to engage with specialist pain services. Delivery of this work will be in line with the principles of the TEC Programme including inclusion, fairness and choice in order to ensure no one is left behind in the design and delivery of new services and pathways.

The outcomes of this work will be shared at the national level to understand how it can be implemented to improve services and enhance the experience of people with chronic pain across all Health Board areas. Outputs from this work are also expected to identify opportunities and challenges to digital delivery of care for people with chronic pain, including improved data collection and reporting, better service design, increased workforce development and inclusive engagement of people with chronic pain in the services they use.

Increasing the impact of our actions

Remobilisation of pain services and support

We know that the impact of the COVID-19 pandemic continues to be felt across our NHS and on people with chronic pain, many of whom continue to face delays in accessing both pain management and other health and care services. Work is underway to provide support while people are waiting for treatment, including waiting list validation processes to assess individual patient needs, improving information on NHS Inform to increase awareness of options for additional support, and assessing how to identify and meet the wider wellbeing needs of patients.

Through the delivery of the Scottish Government's NHS Recovery Plan there will continue to be major investment in services, including those used by people with chronic pain. This includes delivery of the National Treatment Centres (NTCs) for planned elective and diagnostic care, which will deliver high volumes of orthopaedic procedures for people with osteoarthritis. Given the key role NTCs will play in addressing waiting lists for pain-relieving treatment, we will consider how pain management support can be integrated as part of pre- and post-operative care pathways. This will greatly enhance recognition of chronic pain and its impact on people awaiting treatment, as well as significantly boosting national capacity and timely access to care for a large proportion of people living with persistent pain in Scotland.

Improved coordination of care across services

The working group for this Aim will identify how service delivery for people with chronic pain overlaps with other clinical pathways. This provides an opportunity to inform and influence the delivery of other Scottish Government service improvement priorities. Current and planned activity on long-term conditions includes delivery of the Women's Health Plan commitments on endometriosis, development of a 'once for Scotland' approach to rehabilitation, and implementation of local care coordination roles for people with 'long COVID'. Providing comprehensive, system-wide input will support a more coordinated approach to service planning for people with chronic pain and other associated conditions.

Improved local access to advice and care

We know that most people with chronic pain initially approach primary care services in order to access the advice, support or onward referral appropriate to their needs. In addition to the Actions we are delivering through this Framework, substantial investment continues to be provided to improve delivery of these primary care services in Scotland with expanding multi-disciplinary teams , including additional pharmacists, physiotherapists and occupational therapists supporting general practice. There has also been considerable progress in improving access to local support for mental health and wellbeing which is a key component of care for people with chronic pain through the Primary Care Improvement Fund and the Mental Health Strategy. In addition, the new investment in Mental Health and Wellbeing Primary Care Services will create additional roles in primary care settings. This will substantially increase the mental health workforce and transform how support is delivered.

In recent years work has also been carried out to identify issues affecting access to specialist chronic pain services and what actions could improve delivery and reduce waiting times. This includes service improvement projects in Health Boards across Scotland supported by the Centre for Sustainable Delivery (CfSD) Modernising Patient Pathways Programme (MPPP). Outcomes from these projects indicate improvements in patients' reported quality of life, increased clinical confidence in supporting patients with chronic pain, reduced demand for GP appointments and effective and safe prescribing of medication to manage pain. We will continue to engage the expertise provided by the CfSD in the delivery of this Aim and implementation of the wider Framework in order to support rapid deployment of new ways of working, innovative approaches and safe, fast and effective care pathways for people with chronic pain in Scotland.

Next steps

The first meeting of the NHS Pain Service Managers Network has already been delivered, and actions to review the SNRPMP, launch the remote healthcare pilots and carry out the HIS Gathering Views exercise are expected to begin from the Summer of 2022.

We intend to establish the working group for this Aim later in 2022, following the formation of the Aim A SLWG. The group will make a series of recommendations for improvements in pain management service access, planning and delivery which will require action at the local and national level.

It is expected that future issues this group will consider are likely to include the feasibility of implementing national approaches to referral, including the opportunity to consider increased use of regional and national care pathways. This work will contribute to more sustainable local services, more consistent and timely access to appropriate care, and improve the experience of people with chronic pain of the services they need.