Pain Management Task Force minutes: September 2023

Attendees and apologies

• Stuart Stephen, National Implementation Lead for Pain Management, Scottish Government 
• Nicola Rhind, National Clinical Lead for Pain Management
• Aline Williams, Pain Service Manager Network Lead
• Rory Mackenzie, Associate Clinical Director, NHS Centre for Sustainable Delivery (CfSD)
• Martin Dunbar, Third Sector and Lived Experience Representative
• Lyn Watson, Pain Nurse Network Lead
• Gayle McCann, Senior Policy Manager, Scottish Government 
• Sharon Robertson, Policy Manager, Scottish Government 
• Tracy Robertson, AHP network Lead
• Debs Steven, Pharmacy Network Lead
• Lars Williams, Medics Network Lead

Apologies

• Lynne Nicol
• Nicci Motiang
• Nina Cockton
• Helen Moores-Poole
• Lynne Railston
• Lois Lobban
• Stephen Martin

Items and actions

Welcome and apologies

Both the Chair and Deputy Chair are absent. It was agreed that the Implementation Lead would go through the agenda items and feedback to the Chair so that they can sign off any key decisions.

Previous minutes and matters arising

Previous minutes were agreed.
Matters rising

• review Scottish Social Services Council badge system (Action 3, 4 and 14), Ongoing
• feedback on agreed actions from meeting with Remote Healthcare Pathway (RHCP) Lead (action 10), see emerging risks 
• feedback required on scope of the review (action 11), submitted to Scottish Health Technologies Group (SHTG) and decision is awaited on next steps.
• present the Framework to Professional Advisory Group, meeting still to be scheduled

Implementation Progress 

Service Managers Network - identified workforce as a risk – gaps in psychology posts and emerging gaps in some other areas (see emerging risks).

Remote HealthCare Pathway – pilot has been completed on initial pathway, however the project team have moved onto other areas which has highlighted a risk to the rollout to other Boards (initially NHS Grampian and Ayrshire and Arran) of this initial pathway and evaluation. It also means that looking to enhance this pathway from an online screening tool may be slower. Meeting with aforementioned boards being organised. 

Nurses Network meeting – workforce has also been identified as an emerging risk. Looking as a collective to progress along with professional development to look at the role of Clinical Nurse Specialists to see if progress to implement similar to AHP (National Clinical Lead thinks that this links into level 3 and 4 and credentialling).  She will speak to NHS Education for Scotland (NES) about the gap identified (or consider if this would this be suitable for Networks and what are the core skills

Task Force asked to note that specialist nurses are finding it difficult to get onto a prescribing course unless they go on the assessment skills components. Advanced Nurse Practitioners NPs get on it so this may cause issues.

Data collection - highlighted timing issues about further development and that psychology data collection is proving challenging.

Education Group – have been looking at the modules for Turas hub and reviewing resources that are fit and suitable to refer to. Noted that if referring to external websites that there are clear reasons why we are doing so. It would be good to find out how others refer to external websites including private companies and governance around data protection. Is there governance of external resources used by Scottish Government or NHS. Perhaps to consider the use of a caveat e.g.  flagging that the full website is not endorsed. Agreed it was important to get this right for a vulnerable group of people and maintain patient trust.

NHS Fife are happy to share the criteria that they are using for referring to external sources.

23/24-year 2 and beyond Implementation Plan update

The date for feedback closed on 31 August and over 30 MS forms were received. Consultation events have been held with the Networks, members of the Cross Party Group for Chronic Pain, stakeholders, and other policy areas. 

Work has now started to review all the feedback to identify themes and opportunities for improvement.

Lived Experience

Discussion held on lived experience moving forward as the work of the HIS Gathering Views exercise and the two reports from the Pain Patient Panel have now been completed. 

Looking at options on how to ensure lived experience is gathered going forward.

Need to ensure – 

• clear and transparent on how people are recruited to the panel 
• focus on what matters to patient 
• clear on what the ask is
• how can we hear from the majority 
• local services – can groups in their areas be involved (e.g. a group is working on high-risk pain medicines in NHS Fife) 
• SLWGA – developing a framework on engaging with lived experience using local and national engagement

Emerging risks 

Workforce

Workforce - Different issues nationally – funding reallocated if posts left vacant for a length of time, difficulty in recruiting, lack of suitable candidates, redesign of services, patient complexity. This is resulting in a risk in terms of quality-of-care provision, meeting the waiting times standard and the ability to provide pain management programmes.

Implementation Lead highlighted the Faculty of Pain Medicine are currently running a gap analysis exercise/

It was proposed that a working group be convened to look at this issue. Remit to be agreed and Chair will be asked to endorse this approach. The Implementation Lead will organise a meeting with the Service Managers Network Lead and Clinical Lead to work up a proposal.

Scottish National Pain Management Programme (SNPMP)

At a recent meeting with NSD, the programme manager of SNPMP highlighted a low referral rate. Potential reasons identified for this were - late acquisition of funding; staffing pressures in health boards (mainly vacant psychologist posts) causing delays in patient referrals or lack of clear guidelines for referrals into the SNPMP. 

Clarification on the numbers and to look at reasons for any low numbers will be sought from the board.

Asked to consider mapping what is available through the  SNPMP and if there scope to provide different levels of pain management programmes to complement the intensive programme. Reminded that when the SNPMP was established it was not meant to replace the boards running full services in their areas. 

The Policy Team will continue discussions with NSD about the referrals etc which is important due to the proposed change to funding model next year. 

CfSD Funding

CfSD funding has been allocated on an annual basis and CfSD have outlined a programme of work that will continue beyond the end of this financial year. 

In the following year(s) there is a risk that key pieces of work undertaken by the CfSD will not be able to continue or start, without the certainty of a longer-term commitment to funding from Scottish Government. 

Finance and commissioning

Proposed that the SLAs to Boards will be extended to the end of the Financial Year and this was agreed. 

Communications

Drafting of the newsletter and Scottish Government webpage is continuing. Decision still to be made regarding the format of the reports of task force meetings which are to be published. Pharmacy will share a copy of their flash report to see if it would be suitable.

Any other competent business 

None

Date of next meeting:

Wednesday 01 November 2023 at 10.30 am via MS Teams.