NHS Grampian 1
Chronic Pain Service Proposal
Chronic Pain Service Proposal
NHS Grampian
This proposal seeks Scottish Government Health Department funding to support a two year
programme of service improvement to more effectively and efficiently meet the increasing need
presented by people with chronic pain. In order to achieve this aim, we perceive the main task
at hand be to develop a biopsychosocial self management model of care in the community and
up skill the knowledgebase of key functions across primary care and as such improve the
services at Level One of a Tiered model of care, which we perceive as being the currently least
developed Tier within the field of chronic pain. This would entail making sure that patients’ get
the earliest possible and most appropriate treatment locally, but with ready access to specialist
services when needed, in line with the Scottish Service Model for Chronic Pain and forthcoming
SIGN Guideline.
For a self management approach to be successful, it is crucial to deliver it in a way that is
acceptable to patients and does not make them feel that they are receiving an inferior service,
and as such the implementation of this we think will have to be by very specialist staff. For any
changes to services to be truly evidence based, we further wish with support from specialist
academic staff to evaluate all projects to a high scientific standard, so that the effectiveness
and efficiency of all projects can be demonstrated within a scientist-practitioner model, both to
make sure that the changes implemented are of clinical benefit and to due this opportunity to
add to the evidence base within the field of chronic pain management more widely.
In order to achieve our aims, and thereby allowing as many patients as possible to be treated in
the community, we believe there is a need to both up-skill primary care staff and develop Tier
One pain services as a viable and preferable alternative, fully utilising established and
evidence-based self management approaches.
We envisage this to take the form of a multi-stranded approach involving complementary
streams, training primary care staff in chronic pain management and self management and
psychosocial aspects of chronic pain, involving both communication that support and
encourage patients towards an understanding of their pain as a phenomena that requires self
management and developing a service that delivers upon the key elements of quality, being
safe and sustainable, clinically effective and patient centred.
NHS Grampian 2
Chronic Pain Service Proposal
NHS Grampian Service
The local service is based in Aberdeen and provides a specialist Chronic Pain Consultant
service which is made up presently of 3 Consultants, a Clinical Fellow, a Psychologist, a
Psychiatrist, a specialist physiotherapist and specialist nursing. The local service has been
under significant pressure over the last 2 years with transfer of the Elgin service to Aberdeen.
The service is extremely keen to develop links with primary care in a way that bridges the gap
between tier one and two as detailed in the Scottish Service Model for Chronic Pain. The
service provision that is lacking is this bridge between what GPs provide and the specialist
interventions. There are significant numbers of patients who presently don’t get the best service
due to lack of resources and alternatives to offer the patient in their journey of accepting their
long term condition and how they will cope. It is widely accepted there is no new funding and
we need to make better use of what allocation already exists. This is about shifting the care to
the right setting with the right support at the right time for each patient.
NHS Grampian’s strategic development plans will enable our aims to be achieved as our clinic
activity relocates to a new purpose built facility in December 2013, The Health Village. The
ethos of this community based facility is to maintain the patients well within the community. It
will house some key secondary care services that have a heavy patient group that fits this
ethos alongside social work, voluntary sectors and other support networks to help integrate
these with patients and clinical teams raised collective awareness and collaboration improving
the range and quality of services to patients.
Proposed Developments
1. Primary Care educational package
To scope the requirements for Pain education across Primary Care to assess the
needs of GPs, Physiotherapists and district nurses and other interested parties. From
this initial work establish the most effective delivery method that will provide the
greatest impact to the broadest audience and test this. This could be the GP
scholarship scheme or a primary care based package. The initial work will establish the
direction and content of the programme that will follow.
2. Tier one pain service project
 Rolling out an online Level One, self management course; Pathway Through Pain

Developing a manual for self management in chronic pain, pulling together relevant
information in an accessible format utilising the web-based educational resources
developed by the National Steering Group for Chronic Pain

Delivering a brief, structured multi-disciplinary self management/educational group
intervention in a community setting for patients referred, aimed at reducing the rate of
subsequent requirement of secondary care pain service services
3. Practice-Based Community Project

Development of a Chronic Pain Toolkit for first line management that can be launched
as a tool accessible to all healthcare professionals to use including health point staff,
with appropriate sign posting accessible online and in print with links for GPs and
NHS Grampian 3
Chronic Pain Service Proposal
Physiotherapists, involving a directory of resources, e-Health and the third/voluntary
sector of available and appropriate pathways across the four tiers. Launch to include
training of health point staff in the use of toolkit.
Through the initial scoping exercise we may alter focus depending on the findings but the
overall direction will not alter. Our ambition is to use this opportunity as a test of change and
demonstrate the impact of these activities with a view to continuing the programme in the
future.
Resources
The project will be managed formally with auditable minutes and actions shared with the
National Scottish Pain Steering Group. The specialist team supporting these developments will
be:
Band 8b Clinical Psychologist/Lead- Dr Lene Forrester
Band 8a Specialist Physiotherapist – Mrs Nicola Rhind
Consultants – Prof Chambers/Dr Kanakarajan/Dr Nagaraja
Practice GP – to be identified
Specialist/Research Nurse/Assistant – to be recruited
Admin/secretarial support – to be recruited
Christine Leith/ Tara Murray - Management support
Health Economist – Dr Paul McNamee, Health Economics Research
Unit, University of Aberdeen
GP Advisor with special interest/expertise in pain – Dr David Watson
An extended team will be identified as part of this scoping exercise to include patients and
representatives from the third sector. In addition governance arrangements will be ensured
through the involvement of a non executive representative from the board. The aim of the wider
group is to test the scope and delivery methodology will deliver our agreed objectives.
All our projects will be evaluated to a high scientific standard in order that they provide an
evidence base for service change. This will be achieved with support from specialist academic
staff in order that effectiveness and efficiency can be demonstrated within a scientistpractitioner model. This will ensure that proposed changes are of clinical benefit. This will
further add to the evidence base within the field of chronic pain management more widely.
The projected expenditure against each resource may well alter depending on the initial
scoping exercise but will remain within the overall budget. A full and transparent process will be
audited to detail revised plans and what each resource will deliver for the funding allocated.
Monitoring, Reporting & Evaluation
Expected Outcomes
 Service users and their carers will have a better understanding of chronic pain as a
long term condition requiring self management
 Services users and their carers will have local access to self management tools and
training earlier in their care
 Up to date and comprehensive information on local services is readily available and
accessible
 Service users receive a multidisciplinary assessment early in their care
NHS Grampian 4
Chronic Pain Service Proposal
 Staff who are involved in the care of patients with chronic pain are more
knowledgeable and confident in advising and supporting them
 Staff will be more aware of how and when to access further support when needed
 Resources are used effectively. Patients are referred and move through pathways
appropriately
 Current and new sources of local self care education (e.g. Pain Association Scotland
courses) are supported on an ongoing and sustainable basis
 Achievement of access targets at all stages of the pathway
Measurement of the expected outcomes before, during and after the programme will
allow the programme to be evaluated. Timescales and interim goals will be further
developed and the monitoring and reporting progress be implemented.