National Advisory Committee for Chronic Pain minutes: November 2019

Attendees and apologies

Attendees

• Dr Gregor Smith (GS), Deputy Chief Medical Officer (Chair)
• Prof Blair Smith (BS), National Lead Clinician for Chronic Pain, NHS Tayside
• Sara Redman (SR), The Health and Social Care Alliance (3rd sector rep) 
• Sonia Cottom (SC), Pain Association Scotland (3rd sector Rep) 
• Angela Donaldson–Bruce (ADB), Versus Arthritis (3rd sector Rep) 
• Anita Stewart (AS), Scottish Government (Clinical Priorities)
• Carolyn Chalmers (CC), Scottish Government (Modernising Patient Pathways)
• Pauline Bennett (PB), Scottish Government (Secretariat)

Meeting guests

• Mary Rose (MR), NHS Lothian
• Suzanne Krosner (SK), NHS Lothian
• David Gunn (DG), Royal College of GPs
• Emma France (EF), University of Stirling 
• Karen Auchincloss (KA), Scottish Government (Clinical Priorities) 
• Gordon Frame (GF), Scottish Government (Scheduled Care)
• Fiona McKinlay (FMc), Scottish Government (Child Wellbeing)

Apologies

• Prof Lesley Colvin (LC), University of Dundee 
• Patricia Roche, Pain Concern (3rd sector Rep)
• Phil Mackie, Scottish Public Health Network
• Marianne Hayward, Health and Social Care Partnership South Lanarkshire 
• Paul Cameron, NHS Fife
• Grecy Bell, Associate Medical Director NHS Dumfries and Galloway 

Items and actions

1. Welcome and introductions 

GS welcomed everyone to the meeting, and noted apologies.  

2. Previous minutes 

GS advised that feedback received from the Cross Party Group (CPG) on Chronic Pain expressed concern over wording of the previous minutes and the delay in publishing the minutes. The Scottish Government aims to publish minutes within a month, however, for various reasons this is not always possible.

The CPG has been critical of new Clinical Lead job advert being focused on primary care, however, the CPG wishes to clarify that this is not an attack on building capacity in community services/primary care. The CPG’s criticism is that they feel the challenges facing specialist clinics are being side-lined – this is in a context of approx. 20,000 new treatment referrals to specialist clinics in 2018 and (via FOI) over 40,000 return appointments (that are not nationally reported). The CPG also questioned why staffing numbers obtained through a specialist workforce survey was shown in sessions and number per 100,000 head of population rather than raw data. The reason for this is that the workforce of specialist pain clinics do not spend 100% of their time in this role, hence most accurate picture is obtained by establishing the number of sessions for consultants or WTE for other professions. It is relevant to indicate the number by 100,000 population and is a standard term used across the NHS and other organisations to indicate the level of resource allocated.

3. Review of previous actions 

The following actions remain outstanding and the secretariat will follow up by email before the next meeting:  

Outstanding actions

• Action 3: Discuss implementation of SAC chronic pain report with primary care colleagues and report back. (Grecy Bell)
• Action 11: Declaration of interest forms to be completed and sent to Secretariat (covers previous 3 years). (All)

4. Work themes  

Chronic Pain dataset update – AS provided a brief update on first steering group meeting held by NHS Information Services Division (ISD) to progress the rollout of the core minimum dataset for chronic pain. The group comprises third sector and lived experience representation – with plans to undertake wider engagement in coming months. There is recognition that this is the first phase to broadening data collection and ensuring consistency across Scotland. ACTION – Share minutes of steering group with NACCP 

First Minister’s National Advisory Council on Women and Girls (NACWG) – the council’s secretariat has approached all national advisory committees including NACCP to explain its remit and to promote the consideration of gender inequality during policy development. GS explained the Chief Medical Officer’s directorate is in the process of formulating a Women’s Plan to tackle gender inequality. NACCP agreed that any policy work for chronic pain should involve an equality impact assessment (EQIA) that would include consideration of gender inequality. ACTION – Find out if an EQIA exists for the Modernising Patient Pathways Programme and/or Scottish Access Collaborative Programme. 

Atlas of Variation – AS thanked the committee for its involvement in submitting suggestions for the focus of maps and confirmed five maps are expected to be published in March 2020 with a narrative about prescribing for pain management showing geographical, deprivation and gender variation. The purpose is to generate debate about the variation across the country and to stimulate dialogue about local actions to address unwarranted activity, including the wider context of supporting self-management, education and social prescribing. 

Waiting times - GF delivered a presentation on waiting times. GS thanked GF for highlighting the inconsistencies with data, which emphasized the importance of improving data for chronic pain. The Committee discussed the detail of the data and GF/CC agreed to follow up queries with ISD and Health Boards. ACTION. GS also spoke about Health Board Annual Operational Plans – the data provided by Boards will be scrutinised to account for progress against government priorities.

5. Scottish Access Collaborative (SAC) – Next steps/update 

CC outlined that two appointments have been made to support the Modernising Patient Pathways Programme to act on the Scottish Access Collaborative report on chronic pain. Emma Mair is an AHP Lead from NHS Ayrshire and Arran, who has experience of working in primary care and specialist clinics for chronic pain, is appointed as Primary Care Clinical Lead for Chronic Pain. Kieran Dinwoodie is a GP Partner from NHS Lanarkshire who has an interest in chronic pain, and is appointed as National GP Advisor for Chronic Pain. 

With these appointments in place, CC explained the priorities/ plans for progressing work including involvement of lived experience group, webinars to share practices around the country and updating the chronic pain content on NHS Inform. 

6. Management of chronic pain in children and young people – update 

In LC’s absence, BS provided a summary of actions to date. MR, DG, SK and EF joined the meeting at this point. The Committee had received an outline proposal prepared by DG of the Royal College of GPs that would result in an eLearning module about the management of pain in children and young people. GS explained that there are different training routes including the NHS Education for Scotland that also deliver a specific programme for GPs. MR acknowledged there is a huge need for education amongst GPs but the existing guideline published in 2018 provides much of the information that the Royal College module would contain. GS summarised the committee is supportive of implementing the guideline but recommends further consideration of how this can be achieved. ACTION – Secretariat to follow up with LC, DG, MR and EF. 

 7. Any Other Business 

AS mentioned that the Scottish Government intended to publish a Framework for Action on Neurological Care and Support in December 2019. This sets out a vision, aims and commitments to improve access to health and social care for this population. AS asked for comments about whether the Scottish Government should publish a statement of intent, summarising national policy for chronic pain. The committee welcomed this suggestion and would be pleased to support development of a statement. ACTION – AS/ CC to consult relevant policy areas and update Ministers to seek their views.

Outstanding actions from previous meeting - (Secretariat to follow up) 

3	Discuss implementation of SAC chronic pain report with primary care colleagues and report back. (Grecy Bell)
11	Declaration of interest forms to be completed and sent to Secretariat (covers previous 3 years). (All)

Agreed actions 

1	Secretariat to share minutes from the ISD steering group for chronic pain dataset with NACCP.
2	CC to find out if an EQIA exists for the Modernising Patient Pathways  Programme and/or Scottish Access Collaborative Programme.
3	GF/CC agreed to follow up waiting time queries with ISD and Health Boards.
4	Management of chronic pain in children and young people  - Secretariat to follow up with LC, DG, MR and EF.
5	Statement of intent, summarising national policy for chronic pain - AS/ CC to consult relevant policy areas and update Ministers to seek their views.