Siân Jones MBA– Business Development Manager, Red Kite.
Monika Rusiecka MSc – Pain management Practitioner, Red Kite.
Chronic pain is recognised as a growing problem, affecting between one-third and one-half of the UK population (BNF). As outlined as early as a 2006 study by Brevic, persistent pain accounted for around 20% of all primary care attendances, a percentage that continues to increase with an ageing population.
In recent years a majority of well-known and respected organisational bodies have released new and updated guidelines on how to tackle this problem and provide support for patients, including, the International Classification of Diseases 11th (ICD-11: 2022); Classifying Primary Chronic Pain Conditions as a disease state, that requires appropriate management; and the Living with Persistent Pain guidance – a refreshed document by the Welsh Government (2023). Guidance which focuses on improving awareness of persistent pain and advising on the range of management techniques and online tools available to improve management.
Although each guideline tries to address different aspects of pain management, our work in this area identified that both capacity and a uniform approach to delivering the aims of the guidance and improve the support for this chronic condition was lacking. Our aim was to provide the same level of provision that currently exists for patients suffering from other chronic condition in a primary care setting.
How did we do it?
We are Red Kite, a small community interest company, delivering health and care services that support the sustainability of primary care. We may be small in numbers but our aspirations to deliver modern and sustainable health solutions certainly make up for it. Our latest project, being the development of a persistent pain practitioner role in primary care, dedicated to improving the management of this often, debilitating condition.
Through our work, it became evident that there were gaps in provision around persistent pain management, with no dedicated services for early intervention or support for patients presenting to their GP. Additionally, there were no services available for patients who do not fit the criteria for secondary/community care services and a lack of available support for patients at a primary care level to ensure patients are cared for appropriately and efficiently at any stage of their journey.
Our aim was to implement a uniform approach to delivering the aims of persistent pain guidance and provide, at a minimum, the same level of provision that currently exists for patients suffering from other chronic conditions and to improve education and awareness of this condition at a primary care level.
This is why we developed the concept in which any healthcare professional interested in persistent pain management could develop themselves and in turn, implemented strategies that improve the quality of care and support available to patients with persistent pain.
We did this through the training of a pharmacy technician based in primary-care, with a keen interest in the management of pain. Working closely with local GP practices, we have
introduced practice-based patient clinics, educational sessions and the development of a go-to system to improve the management of pain in an over-burdened, primary-care system.
Our hope is to see a dedicated Pain Management Practitioner available across primary care GP Practices,
- to support GPs and other clinicians with prescribing and reviewing analgesia regimes.
- to ensure continuity of care for patients suffering from persistent pain, including
- patient education on their condition and modern self-management strategies
- putting in place and regularly reviewing a management plan that is relevant to the individual
- provide support for the patients during flare-ups, that might occur.
- being a one-point of contact for specialist Pain Management settings, providing additional information or to receive handover advice about individual patients.
- to raise awareness of modern Persistent Pain Management strategies in local communities, to empower patients to take their health and well-being into their own hands.
What have we achieved?
The primary care pain management intervention is a welcome addition in terms of the management and future management of persistent pain. The service has enabled primary care to support national guidance for the treatment of persistent pain being classed and treated as a disease state. A tailored service provides support in dealing with the increased demand in an over-burdened system and will be vital to ensuring patients can appropriately manage their pain symptoms and improve their quality of life.
Results have already shown:
- 63 patients receiving a person-centred assessment to identify factors contributing to pain and how this affects their life.
- Increased awareness and education across primary care
- The ability to meet government guidance for the management of pain
- Reduced and appropriate prescribing of pain medication
- Increased capacity for GP/Pharmacy
- Improved patient care
- Improved partnership working to develop a whole-system approach
- Reductions and interventions in line with the national prescribing indicators
- Development of MDT roles within primary care for the future
I can see light at the end of the tunnelPatient2023
This service makes a massive difference to my lifePatient2023
A sensible approach. Reduced prescribing, appropriate follow up and reduced workload for GPsGP2023
We are now planning to extend the service through outreach and support for patients diagnosed with osteoarthritis, improving the understanding of joint health as well as a
tailored exercise routine considering patients’ lifestyles and abilities. Additionally, we have started to upskill other members of the primary care team in pain management practice. We will continue to support patients as well as clinicians to ensure we work towards providing gold-standard care for patients living with persistent pain.
During the service development, we have learned some valuable lessons, one of them being that clinicians are very welcoming to change in the management and care of persistent pain patients as long as trust and professional boundaries are established. We have also learned that paradigm shifts in patient care need time to allow for natural organisational changes and adaptations but when implemented, benefit both patient lives and in-turn reduce costs and time to the NHS.