Pain management - service delivery framework: implementation plan

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.

You told us

In the consultation document this Aim was titled 'Improving Quality of Life and Wellbeing', however a number of respondents felt that this will be a shared outcome across the entire Framework, and the actions more closely aligned with service improvement activity. There was considerable feedback on the challenges that people with chronic pain currently experience in gaining recognition and validation of their condition from different healthcare professionals. It was felt that alongside ensuring more consistent advice was provided to patients, there is a need for improved education and training on pain management, and views were provided on what this should include, how it should be delivered and how best to engage both trainee and existing healthcare professionals on this issue. Respondents welcomed the proposed national Pain Clinical Networks and suggested a number of considerations on how they should operate, be supported and interface with existing national specialty groups, including UK-wide professional bodies.

In relation to the data proposals, there were calls to ensuring continued progress to improve quality and transparency of the existing data that is reported. There were a range of suggestions for what data sources should be considered, how to improve the quality of reporting and how to ensure providers e.g. Health Boards would be held to account to ensure they used and implemented available evidence. It was also clear that patient reported measures should be considered and existing proposals for nationally standardised data collection should be implemented to support this, and other priorities.

On developing national standards for care, respondents provided views on the advantages of this approach, and the opportunities it provided for service improvement working. Feedback was provided on how any such standards might be developed, the stakeholders to be involved and the criteria that should be considered for reporting.

Respondents outlined the potential range of opportunities that were presented by ensuring research is ongoing and supported as part of pain service delivery and development. This included building on existing Scotland and UK based expertise and networks. Information was also provided on potential areas for pain research funding going forward, and how these might be prioritised, as well as on the challenges around securing clinical capacity to delivery this work. Feedback on the importance of research was also provided in relation to addressing existing evidence gaps for certain specialised treatments for chronic pain (Aim C).

What we will do

Promoting healthcare knowledge and skills

Action 14: Establish a national multidisciplinary Pain Education Group.

We have established a new national multidisciplinary Pain Education Group with the support of NHS Education Scotland (NES) to ensure a more consistent approach to education for chronic pain in Scotland. This Group brings together representatives from across key roles providing care for chronic pain, including nursing, link workers, physiotherapy and other Allied Health Professionals, pharmacy, pain medicine and psychology.

The Group will work to identify and agree how existing relevant resources, training modules and professional body guidance can be assimilated into a comprehensive national Framework for healthcare professionals so they have the knowledge and skills required at different levels. They will also consider gaps in training provision, and where appropriate, guide the commissioning or development of further resources. Rather than being prescriptive, it is intended that this work should facilitate service leads and individual practitioners to use the tools available when deciding on the most appropriate training for their staff. The Group will also enable deliberation of training and education needs arising from the wider activities to implement the Framework and the individual Pain Clinical Networks.

Action 15: Deliver new pain management training pathways for specialist and non-specialist healthcare professionals.

Rapid developments in medicine, including evolving technologies, treatments and care models require the healthcare workforce to have the right skills and qualifications to deliver these advancements and meet the future needs of patients. We will support the delivery of new training pathways for chronic pain which recognise the prevalence of the condition, and to reflect the modern multidisciplinary nature of pain medicine.

The Scottish Government is working with the Faculty of Pain Medicine (FPM) to support the development of a new credential for Pain Medicine Specialists as part of the General Medical Council's pilot early adopter scheme. Credentials are discrete modules of learning, regulated by the General Medical Council, that can be accessed flexibly by trained doctors at any stage in their career (e.g. after they have specialised in a particular field) and are based on patient and service need. The Pain Medicine Specialist credential intends to expand the knowledge and skills of a wider cohort of expert clinicians across anaesthetics, rheumatology, neurology, rehabilitation medicine and palliative care. The credential will be available both before and after completion of specialist training (pre-/ post-CCT) and for existing speciality grade clinicians.

Work is also underway to develop and implement a Credential for Advanced Care Practitioners in pain management for those working outwith specialist services, including GPs, paramedics, psychology, AHPs and other related roles. These new training and development programmes will ensure a more holistic approach to pain medicine from a larger cohort of practitioners, increasing the quality of care available for people with chronic pain within and across a range of care pathways.

Improving the use of data for better services and support

Action 16: We will work with Public Health Scotland to improve how we capture and report national data on chronic pain services.

Chronic pain waiting times for specialist services are currently reported on a quarterly basis by Public Health Scotland (PHS). PHS has taken steps to increase the quality and transparency of the data available, with the waiting times report enhanced to provide a greater level of granularity and a more complete picture of waiting times.

The Framework presents a renewed opportunity to continue this work with PHS and ensure there is appropriate oversight of pain service performance as models of care continue to evolve. We will work with PHS, NHS services and clinical leads to evaluate existing data collection and identify opportunities to implement improvements in reporting to more appropriately and fully reflect the performance and quality of services used by people with chronic pain.

Action 17: We will gather data through the Scottish Health Survey to improve the planning and design of care and support for people with chronic pain.

Improved data collection on chronic pain at the population level will support a richer understanding of the prevalence of the condition and its impact on wider society. For the first time, we will include questions on chronic pain in the Scottish Health Survey in 2022 which will help to provide a more detailed picture of the health of people with chronic pain and the other factors which impact on their quality of life and wellbeing such as other health conditions, physical activity and deprivation.

We will support dissemination of outputs from the survey data and will identify opportunities through delivery of the Framework to encourage improved decision making at the local, Health Board and national level. This includes understanding the barriers and opportunities for the use of local-level chronic pain data to guide how Health and Social Care Partnerships (HSCPs) and Integration Authorities (IAs) consider and address the needs of their local populations. We will also identify opportunities for the data to inform other health policies and cross-Government actions to ensure they take into account the needs of people with chronic pain. This Action will increase the profile of the broader spectrum of challenges experienced by people living with chronic pain in Scotland, and promote the design and delivery of more person-centred, effective care and services.

Promoting research and innovative services

Action 18: We will identify shared research priorities to enhance care and services.

Research on chronic pain has continued to improve standards of care and ensure an evidence-based approach to service design. In Scotland we benefit from a vibrant pain research community driven by the NHS Research Scotland Pain Network (NRS Pain). We will work with this network and people with chronic pain to identify shared research priorities including those suggested from consultation on the Framework, to improve treatment, management, quality of life and wellbeing for patients.

Increasing the impact of our actions

Improving the skills of the NHS Scotland workforce

The work of the national Pain Education Group will inform and support the delivery of the Pain-Informed Care toolkit and contribute to the Chronic Pain Knowledge Hub for pain healthcare professionals. Bringing together this expertise will help to develop a more consistent and shared language around chronic pain which is accessible to both people with chronic pain and clinical professionals at all levels.

The impact of the Actions to enhance the skills, knowledge and training opportunities for the chronic pain workforce are complemented by the Scottish Government's overarching approach to improving healthcare services. The Health and Social Care: National Workforce Strategy sets out a series of commitments to recover, grown and transform the workforce, including the Action to: Shape future training programmes to support the development of the pain management workforce. This will help to ensure greater coordination and alignment of workforce actions to ensure they maximise benefit for people with chronic pain and those working in our health and social care services.

Enhancing the use of data in healthcare

Action to continue to improve the quality of data and standards of reporting on pain services will look to learn from other activities underway in this area. This includes ongoing work by the Faculty of Pain Medicine to review pain service delivery across the four UK nations. We will seek to engage with this work and its outputs to understand how we can evolve our approach to national-level reporting of service quality and the opportunities for national standards.

Similarly, as service improvement work is delivered, we will also continue to identify opportunities to promote and embed use of existing service-performance tools. This will include consideration of how the Core Minimum Dataset (CMD) for chronic pain services can be implemented as part of pain management pathways, and the utility of proposed Quality Performance Indicators (QPIs) for pain services. The Action to deliver a Remote Healthcare Pathway for chronic pain is already using the CMD to inform its approach to data collection. This will include a range of relevant patient-reported outcomes including quality of life, mental health issues and pain interference. This will help to establish the opportunities to increase more routine collection and reporting of data that reflects the experience of patients to improve pain services in Scotland.

The Scottish Government's broader approach to data is driven by the Data Strategy for Health and Social Care, currently undergoing consultation. This sets out how we can continue to ensure there is ethical and transparent use of data to improve the quality of our health and social care services. This looks to existing sources of information as well as future opportunities, such as wearable devices and other technology. The outcome of the consultation will help to inform and guide our approach to data on chronic pain services to ensure we improve the experience of individuals and the care and support they are offered.

Research in healthcare

High-quality research often crosses national boundaries, and involves the public in setting priorities. This is recognised by the work of the Scottish Government's Chief Scientist Office (CSO) and underpins its approach to work with the NHS Research Scotland (NRS) networks, including the Pain Network, to support internationally recognised research. Opportunities are also provided by the ongoing work of the CSO's Scottish Health and Industry Partnership Group (SHIP) which is aimed at strengthening innovation in health and social care to improve quality, efficiency and sustainability of healthcare. We will continue to work alongside the pain research community to leverage these and identify other opportunities to promote and support impactful health research and innovation on chronic pain.

Next steps

The National Pain Education Group has already been established and work is underway to assess existing training resources to inform the training and knowledge Framework. Further priorities, including work to deliver the Pain Informed Care toolkit and Pain Knowledge Hub will also be prioritised, with activity aligned to Aim A. We are in ongoing contact with the FPM and other stakeholders to monitor the delivery of the new pain management credentials with updates on progress towards their implementation expected in the coming year.

Work with PHS to inform future potential data collection activity is expected to begin later this year. The Scottish Health Survey for 2022 is in the process of being delivered, with interviews taking place across the coming year and analysis and outputs expected in 2023. The NRS Pain conference is expected to take place later in 2022 and will include representation from the Scottish Government to promote awareness and engagement with the Framework.

Further actions for this Aim are expected to include modelling and analysis of future pain workforce needs and opportunities to support implementation and reporting of the CMD. Going forward outputs from this work will support exploration of how national standards for pain services can be developed in collaboration with the wider pain community.