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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

Chronic Pain in Scotland: Just what have we achieved?

Dr Lesley Holdsworth

Dr Steve Gilbert

purpose of this session
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
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


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
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
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
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
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 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
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
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
Summary: Key learning
  • Hearts and minds
  • Creating the conditions for this to happen
  • Collective will
  • Sustainability