Community based chronic pain assessment and treatment service to NHS Frimley Integrated Care Board

NHS Frimley ICB ("the Commissioner") sought to commission Dr K Lothe and Partners LLP to provide a Community based chronic pain assessment and treatment service.

The normal route of referral into this Service is by a patient's registered GP Practice. Internal referrals may also be received from the Diagnostic Uncertainty service. Frimley Park Hospital Consultants may also directly refer as an alternative to a secondary care pathway for pain management for new referrals. The Community Pain pathway is aimed at patients with persistent disabling pain of more than 3 months or where the referring clinician agrees and accepts that the pain has become chronic. The Community Pain pathway delivers timely skilled interventions to reduce the cause of pain and/or to enable patients to manage their pain with psychological and behavioural support. This is achieved by using an experienced multidisciplinary (MDT) model which has access to a range of medical and non-medical interventions for people living with chronic pain.

The MDT assessment, diagnosis and treatment process offers: Comprehensive assessment of physical functioning and to establish cause for pain; Minor direct interventions such as joint injections to peripheral joints, targeted interventions and acupuncture in line with NICE guidance; Intensive physiotherapy where indicated. Patients requiring a longer course of physiotherapy should be referred back to the patient's GP, with advice to consider onward referral to Community Physiotherapy; Behavioural and cognitive intervention to manage pain; Rehabilitation Therapy; Review of drug regime and discussion with patient on use; Agreed individually designed exercise plan and recognition of the benefits of self-management; Postural analysis and core stability; Patient education to help understand pain and pain pathways; Support and educate GPs to safely optimise analgesia and other pharmacological interventions and promote self-management (booklets, leaflets and other self-help techniques); Support and educate GPs to manage pain flare ups e.g. telephone advice.

The objective of the Service is to: Promote the highest possible quality of life for pain patients; Provide accurate diagnosis, even if this is 'medically unexplained pain'; Advice and support primary care clinicians in managing the pain elements of their patients care; Provide psychological and behavioural interventions that support patients and their carers in managing their pain, enabling them to lead more normal lives with reduced disability; Provide specialist physiotherapist assessment with rehabilitation planning and review including promotion of group programmes; Help reduce recurrent inappropriate admissions and other healthcare services by promoting self-management; Increase social and physical functioning; Promote independence and wellbeing for patients through the provision of structured self-management support thus reducing the need for other medical appointments and admissions; Where appropriate provide direct interventions to reduce and manage pain.