Commissioning the
Dorset Community Persistent Pain
Management Service
Why is it so Painful to Commission Pain
Services?
18th December 2012
Nichola Arathoon
Supporting people in Dorset to lead healthier lives
The Commissioning Cycle
Health Needs
Assessment
Prioritisation and
Workplan
Development
Manage Quality
and Outcomes
Current Service
Review
Manage
Performance
and Demand
Service Design
and Planning
Contracting &
Implementation
Securing the
services
Supporting people in Dorset to lead healthier lives
Background
• Secondary care delivered injection based service in three
acute providers
• Long waits for repeat injections
• Patient complaints
• Press involvement
• Board of Governors
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Service Review
Service review Pan Dorset
• Complaints
• Pathway
• Activity
• Capacity
• Funding
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Service Redesign
• Best practice research
• Interventional Procedures in the Management of
Spinal Pain Policy
• Multidisciplinary team triage of new patient
referrals
• Post injection patient diary
• Increased funding for backlog patients on to new
pathway
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Service Redesign
Service Specification for bio psychosocial model of pain
management
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Dorset Clinical Commissioning Group
MSK Clinical commissioning Programme
Dorset Pain Society
Patient and carer involvement
Secondary care involvement
Primary care involvement
Education
Supporting people in Dorset to lead healthier lives
Dorset Community Persistent Pain
Management Service
ETHOS:
To enable adults living with persistent pain (of at least 3
months duration with a definitive diagnosis, including
Medically Unexplained Symptoms, and/or when the
patient and GP agree and accept that the pain has
become chronic) to understand and come to terms with
their pain and to adopt strategies for living, which allow
them to lead as fulfilling and independent lives as
possible.
Supporting people in Dorset to lead healthier lives
Dorset Community Persistent Pain
Management Service
To encompass:
Primary care education
The provision of supported self-care and optimised medical
therapy delivery in Primary Care at the onset of pain and
appropriate onward referral to the Community Pain
Management Service
The clinical service
The provision of enhanced pain management treatments and
strategies
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Primary Care Education
• To support GPs in enabling their patients to live with
persistent pain
• To work with and educate GPs to safely optimise the use of
analgesia
• To educate GPs in the benefits of self management tools
and techniques including motivational interviewing, the
Expert Patient Programme and the Pain toolkit
• To identify and work with GPs with a Special Interest in
persistent pain management
• To refer patients to the community persistent pain
management service in a timely manner
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The Clinical Service
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Community based
Locality provided
Single point of access
Multidisciplinary pain specialist team: Physiotherapist,
Occupational therapist, Psychologist, Doctor and Nurse
• Interdisciplinary working with Secondary Care clinicians,
community health services, medicines management teams,
community mental health teams, substance misuse teams,
community matrons, return to work services and voluntary
agencies
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The Clinical Service
• Triage of referral form
• Individual assessment and screening in to appropriate
support/treatment
• Personal care plan with goal setting and review with key
worker
• Provision of cognitive and behavioural therapies with
psychological support
• 1:1 and/or group pain management – health professional or
peer led
• Interventional therapy
Supporting people in Dorset to lead healthier lives
Peer Support
• Within groups
• Pain Chain/buddy
• Telephone help line
• Dorset Pain Society
• Peer led pain management courses
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Lessons learned
Stakeholder engagement
• Secondary care clinicians and managers
• Primary care clinicians
• Patients and public
Communication strategy
• Current providers
• Current patients
• Media
Information and activity
• From current service in to new service
Supporting people in Dorset to lead healthier lives
The Commissioning Cycle
Health Needs
Assessment
Prioritisation
and Workplan
Development
Manage
Quality and
Outcomes
Current
Service
Review
Manage
Performance
and Demand
Service
Design and
Planning
Contracting &
Implementation
Securing the
services
Supporting people in Dorset to lead healthier lives
Thank You
Any questions?
Nichola.Arathoon@dorset-pct.nhs.uk
Supporting people in Dorset to lead healthier lives