Ffion John and Alec MacHenry
Hywel Dda University Health Board with industry partner, OSP Healthcare
Currently available services are struggling to cope with existing demands in the HDUHB area, where a higher population aged between 55 and 79 and large rural area only increase demand. Our service has improved this situation, but over 50% of patients, despite opting in, don’t feel able to attend a face:face pain management programme.
Improving access to evidence based self-management options is critical in meeting the needs of this population and in building social resilience. Failure to do so has significant psychological, economic, social and health care resource implications.
Our project provides an innovative, prudent and sustainable way of meeting this need. A digital Pain Management Programme will help more people engage and improve their management of a debilitating lifelong condition.
The aim of the project was to develop a sustainable product that would enable people living with pain to access high quality education and intervention as soon as is appropriate in their persistent pain journey.
The digital e-learning Pain Management Programme (e-PMP) can be completed in Welsh or English, offering the people of Wales an opportunity to access their intervention in their chosen language. The e-PMP has the potential to be adopted by other Health Boards in Wales and further afield.
The ability to offer the e-PMP at the earliest possible point in the person’s care would decrease demand for secondary pain services, increase provision for persistent pain intervention in primary care, and create an ability to use scarce resources more prudently.
The impact would see a decrease in waiting times for assessment and provide an increase in choice of intervention for people who cannot, or choose not to engage with a face:face or virtual PMP. This is a very real challenge for us and many other pain services, as we consistently observe high levels of non-engagement. The reasons for this are various and include: limited rural transport availability; time constraints; mental health; physical health and mobility problems. With little other option available for these people, the likelihood of a re-referral into the system is high. The e-PMP would be a sustainable solution to addressing this and offering people more choice in their care.
Honestly, we were challenged by many things this year, Covid-19 being a major factor with the redeployment of key stakeholders as well as the furloughing of staff. This halted progress for some months.
The main challenge was realising the scale of the project. We quickly agreed that what we wanted to develop could not be achieved by creating an ‘app’ as initially thought. Close collaboration with our industry partner and a shared vision for producing a high quality product meant that we opted to develop an e-learning programme based on our existing PMP. This would then be delivered in a Learning Management System (LMS).
The cost exceeded our budget and the project was paused whilst further funding was sought. The funding to complete the project was agreed in December 2020.
As the project is still in development, we don’t have any outcomes to report as yet, however a breakdown of costings would suggest that if we were able to reduce the delivery of our face:face PMPs by half, we would be able to reinvest 1,260 hours / 168 clinical days of work per annum (including over 500 hours driving time) into the service – increasing our capacity to reduce waiting times for initial assessments and interventions.
A research proposal is currently in the system, which will hopefully enable the efficacy of the e-PMP to be demonstrated as soon as the e-PMP is complete.
We continue to believe that this product will have a positive impact on patient care, choice and enable more people to access high quality pain management education earlier in their journey with pain, which could influence their choices about living with pain, including activity levels, medication use and engagement with life. Understanding their pain will enable them to continue to live life with pain as opposed to allowing their pain to significantly impact on their life choices and trajectory.
The immediate next steps are to complete all 20 modules (10 Welsh and 10 English) and integrate the modules into a custom designed and built LMS.
Once the e-PMP is complete we will test it’s functionality with service users and peers, making any amends required before beginning the study to evaluate its efficacy.
Once we have data, we will be able to promote its use to other HBs in Wales and further afield.
Our Exemplar Experience:
Being Bevan Exemplar has been a very rewarding experience. Not only has it provided a platform for us to develop our innovative and creative ideas and bring them to life, they facilitated our relationship with our industry partner, and allowed work to begin immediately – a process that would have routinely taken many years to come to fruition.
The workshops and events that have been offered to us, and the relationships we have developed with the Bevan Commission team and personnel in our own HB have been invaluable. It has been an honour to be part of Cohort 5 and we would recommend this to anyone who enjoys hard work, creativity and taking chances in doing things differently.
Ffion John: Ffion.M.John@wales.nhs.uk
Alec MacHenry: Alec.Machenry@wales.nhs.uk
 Elliott AM, Smith BH, Penny KI, et al. The epidemiology of chronic pain in the community. Lancet 1999;354:1248-52.
 Hywel Dda University Health Board Demography Summary 2016. Public Health Wales Observatory.