Chronic pain in scotland just what have we achieved
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Chronic Pain in Scotland: Just what have we achieved?. Dr Lesley Holdsworth Dr Steve Gilbert. Purpose of This Session. Share our story and key lessons learned; Scottish Service Model for Chronic Pain Our approach to implementation, the underpinning theory

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Chronic Pain in Scotland: Just what have we achieved?

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Chronic Pain in Scotland: Just what have we achieved?

Dr Lesley Holdsworth

Dr Steve Gilbert

Purpose of This Session

  • Share our story and key lessons learned;

    • Scottish Service Model for Chronic Pain

    • Our approach to implementation, the underpinning theory

    • The challenges and ways we’ve tried to overcome these

  • What have we achieved?

Chronic Pain in Scotland


  • Pain that persist for more than 12 weeks despite treatment/medication


  • 2012-2014



Based on adult prevalence of 5.6%, CPG 4

Smith BH et al 2001

Treatment Guidelines

The ‘traditional’ chronic pain nightmare


1' representing no problem through to '5' representing the most severe category

(All domains)

1 equates to ‘full health’ and death equates to 0 (EQ5D score).

National median 0.3181

Normal population of same age = 0.80

Transformational Change

  • the organisation and the vision

    NHS in Scotland

  • the peoplewho are part of that organisation

    Service users, the public, third sector, clinicians,

    managers: collectivism

  • the services which the organisation delivers

    Chronic pain

  • the processes which are involved in the delivery of the services

    Implementing the model for chronic pain

    Could we create the conditions?

Creating a ‘social movement’ – the WILL

  • “a group of people with a common ideology who try together to achieve certain general goals ” oxford dictionary

  • to successfully mobilize individuals, need an injustice frame - ideas and symbols that illustrate both how significant the problem is as well as what the movement can do to alleviate it

Our Approach: the IDEAS

Create the conditions, drive & support the agenda

  • Establish the vision, gain recognition – all levels

  • Involve and empower stakeholders, the movement,

  • Set a clear direction, expectations, what, by who and when

  • Provide resources

  • Enable and provide feedback

  • Engender local ownership

    encourage the leadership of followers

The Chronic Pain ‘Execution’

  • Steering group – right membership, transparency

  • Local groups a/a

  • Government recognition, support & involvement

  • Three agreed aims:

    1. Develop a quality improvement infrastructure to support NHS Boards: key aims/plans, education, research, practice

    2. Provide leadership, all levels and opportunity

    3. Implement the model

National and Local Networks

National and local learning days and other ongoing communications to:

  • Create, share and nurture the vision

  • Opportunity to contribute, to be part, to own the change, enthuse others

  • Exposure to examples of best practice

  • Head room to develop and plan local solutions

  • Be involved in national work groups

  • Example 1: Level 1

  • Information/communication - Confusing landscape

  • Variable quality of information for

  • Service users

  • The public

  • Clinicians

  • Local improvement groups

  • Sub group – provided solution: with QA processes

  • @


  • Example 2: Level 2

  • Some areas had programmes for upskilling GPs and AHPs including third sector

  • Shared at national event

  • Local interest generated

  • Resources and experience shared

  • Wider roll out – shared on website and primary care networks

  • Example 3: Level 3

  • Access and reducing waits

  • Triage approach adopted in one area

  • Experience shared at national meeting

  • Other solutions being shared

  • What users think of Level 3 services?

Patient Reported Experience Measure – Must do with me programme

  • Involved

  • Listened to

  • Carers involved

  • Information and advice

  • Outcome of care

  • Overall satisfaction

  • Example 4: Highly specialist services

  • Issue: Variable referral rates of patients for interventions e.g. SPS

  • Working group - all referral centres established

  • National criteria agree

  • Implemented

  • Peer group

Just what have we achieved?

Engaged and Proactive

Service Users

Clinical teams

Third sector


Service Managers

Specialist Interest Groups

Just what have we achieved?

  • Transparent, local and national chronic pain improvement groups

  • Plans with clear and transparent accountability

  • Working groups, resources, communications and sharing networks

  • National leadership, coordination

  • Sustainability, but more work

Summary: Key learning

  • Hearts and minds

  • Creating the conditions for this to happen

  • Collective will

  • Sustainability

Leaders and critically, followers

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