Chronic Pain Stakeholder Event
Wednesday 25th September 2013, 12.30pm
Hampden Park, Glasgow
The following paper details the outcomes from the Chronic Pain MCN Stakeholder
Event held in September 2013. It addresses the initial purpose and aims and
concludes with a summary of the outcomes from the day and ‘next steps’.
The event’s main purpose was to bring together the Chronic Pain Service’s key
stakeholders, approximately 70 in total, from the following groups –
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Medical staff
Nursing staff
AHP staff
Managers from both the Acute Division and CH(C)Ps
GPs
Pharmacists
Patients and patient representatives
Voluntary organisations
In bringing together the key stakeholders in a structured way the service leads were
able to gather ideas and information on the current set up of the Chronic Pain
Management Patient Pathway and to create a vision for the future of pain services.
The format of the day was designed to allow maximum engagement from all named
groups ensuring full consultation and input from all parties.
The event was timed such that outcomes would inform the design and delivery of the
future of the Chronic Pain Service in NHSGGC in line with the Scottish Service Model
for Chronic Pain, which is shown below.
The objectives of the redesign of the Chronic Pain Service are to;
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Provide a safe, high quality and person centred chronic pain service,
Provide better and quicker access to care,
Integrate primary and secondary care services,
Improve links with the children and young peoples’ service,
Improve recognition, assessment and management of chronic pain,
Develop links with the third sector.
Workshops
The event’s primary focus was on two facilitated workshops designed to draw out
valid contributions from all participants.
Workshop 1 asked participants to discuss ‘Where are we now – warts and all’ and
sought to identify which parts of the service work well, which parts don’t work so well
and whether there are elements missing from the service. This was facilitated in
such a way that encouraged participants to identify what should ‘Stop’, ‘Start’ and
‘Continue’. The feedback from this workshop is noted below and where there have
been similar themes/the same issue repeated, these have been summarised into one
response and highlighted in bold;
Stop
Participants felt the following were areas that perhaps didn’t work as well and should
be stopped/redesigned;
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Too much focus on treating pain with medication.
Not enough regular access to services other than medication e.g.
physiotherapy.
Poor management of chronic pain in Primary Care, perhaps there is not
enough time spent in the initial stages of understanding and treating chronic
pain.
Not enough information available to educate patients/GPs/hospital staff on
what chronic pain is and it’s impact.
No availability of a specialist help service when in crisis – reliance on GP.
Long waiting times for the pain clinics resulting in patients returning to the
GP repeatedly.
No availability of a local ‘hub’ where patients can be treated in the
community, through a multi-disciplinary service.
Negative attitude towards chronic pain.
8 week targets allow patients to access the ‘system’ but do not help with long
term care.
Inappropriate and incomplete referrals to pain clinics.
One year waiting list for Psychologist.
Start
Participants felt the following were areas that perhaps don’t feature in the current
service and should be explored;
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Better integration of pharmacy in the overall service/clinics,
incorporating appointments with pharmacists for medication reviews
both in the hospital setting and in the community.
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Improved education for medical staff on chronic pain both in primary
and secondary care. May reduce the number of inappropriate referrals.
Increased communication/awareness about the service and what
chronic pain management is – patient stories/DVDs.
More information on self management of chronic pain in terms of
aids/helps/methods.
Improve triage of patients at point of referral and ensure they are signposted
to the correct part of the service.
Training for specialist pain nurses in the psychology aspects of chronic pain.
Increased psychologist resource.
Provide a community hub where patients can be seen and treated in the
community by a Multi Disciplinary Team.
Introduce a pain management service for adolescents.
Improved information sharing/networks across the organisation – pathways
etc.
Pain management helpline for information and support – both for
patients and community GPs/clinical staff.
Improve access to physiotherapy – increase training for
physiotherapists on all aspects of pain management.
Rapid access to clinics for established conditions.
Improved time and care from primary care providers to reduce the pressure
on secondary care service.
Introduce support groups, drop in service, no referral required.
Continue
Participants felt the following were areas that were successful parts of the service
and should be continued;
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Initial assessment at the pain clinic was good and time was spent
getting to know the patient.
GP support is good.
Psychology sessions (group and individual) are very helpful when available.
Able to see people who have helped quickly.
Pain website is helpful and informative.
Multi disciplinary approach works very well.
GP education events are helpful.
Realistic lifestyle advice tailored to patient needs should continue.
Exercise being a focus from an early age.
Physiotherapy/exercise classes at Gartnavel.
Telephone consultations – should be made available across GGC.
Telephone and e-mail service for GPs.
Involvement of the family/carers in patient care.
Workshop 2 asked participants to discuss ‘Where do we want to get to and how’ and
sought to identify what we would like the service to provide in an ideal world and how
we can work towards this in the current financial climate. This was facilitated in such
a way that encouraged participants to identify the ‘Actions’ and ‘Barriers’. The
feedback from this workshop is noted below and where there have been similar
themes/the same issue repeated, these have been summarised into one response
and highlighted in bold;
Actions
Participants identified the following ‘actions’ as being the areas where activity is
required in pursuing what would be the ideal Chronic Pain Management Service.
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Provide accessible patient information on multiple sites, which should
be validated by the NHS e.g. touch screens, information in hospitals, GP
surgeries, pharmacies, shopping centres etc.
Should be in
print/internet/audio.
Provide care outwith the hospital setting e.g. domiciliary care /
telephone consultation / video conferencing / local clinics (hubs). This
should be an all encompassing approach that provides access to all
services
e.g.
psychology/physiotherapy/3rd
sector
organisations/pharmacists etc.
Provide holistic options in treatment rather than reliance on medication.
Include coding of chronic pain on the GP contract.
Improve education and awareness amongst all health professionals.
Map the services available in Glasgow.
Improve information available for those in work to ensure they stay in work.
Develop education classes for patients with a focus on self
management.
Ensure that resources are fully staffed.
Send text reminders for clinic appointments to reduce DNAs.
Review administration support.
Improve the vetting/triage of patients to ensure they are immediately
referred to the appropriate pathway.
Up-skill GPs/develop pain specialists in the community to reduce the number
of patients having to attend the hospital pain clinics.
Introduce link workers.
Commence joint review processes with GPs and hospital clinicians.
Barriers
Participants identified the following ‘barriers’ as being the potential areas of difficulty
in developing what would be the ideal Chronic Pain Management Service.
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Do we have the IT infrastructure and technology to deliver the ideal service?
Patients often have difficulty with transport.
It can be difficult to manage patients and their expectations.
Currently a lack of knowledge about how the service is delivered and
what is available.
Capacity issues – can services be realigned?
Time constraints.
Availability of specialists e.g. psychology/physios.
Knowledge and/or readiness to self manage.
Cultural issues i.e. expectation that health professionals can ‘fix’
everything, lifestyle choices.
Financial constraints.
Recruiting to specialist roles is difficult when we no longer remain an
employer of choice.
The profile of the pain service is not high enough.
Accessing support outwith normal working hours.
Keeping information up to date.
Clarity of ownership for information resources.
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Current organisational structure.
Conclusions
The event was a well attended event where some interesting and insightful
discussion took place. There was a clear theme running throughout both of the
workshops which centred on education and awareness, not only for patients and
carers but for health professionals in all disciplines. There is a clear need for
additional information being made available both in literature and at education events
across the organisation and in the community. The development of the relationship
with the third sector would be invaluable in taking this forward and would be an
additional level of support available to patients and health professionals alike.
Beyond communication and awareness raising those taking part all appeared to
believe there to be a real need for multi disciplinary ‘hubs’ in the community,
however, in terms of the reality there were a number of barriers highlighted that
would need to be addressed.
Next Steps
In order to gather more clarity and information it was suggested by one of the work
groups that a survey of current resource and usage would give some valuable
quantitative data and the foundation upon which the service could review and
develop services. In support of that focus groups with a sample of those who
attended the session would provide further qualitative data and would allow the
service to explore in more depth some of the ideas and barriers that were discussed
at the event.
It would be advisable to re-run the event in perhaps 6 – 12 months time to review
progress towards the redesign of the service and to once again utilise the knowledge
and ideas from patients and health professionals across the Board area.