Primary Care Pain Support Service
Persistent pain and chronic MSK conditions can represent some of the most complex challenges for primary care. The nature of persistent pain means that patients are unlikely to see a resolution to their discomfort, pain and disability and need to learn to live as effectively as possible with a degree of ongoing symptoms.
Historically, pain management has been based around the traditional roots of physiotherapy orthopaedics rather than medication support. Where people have failed to see significant improvements through these traditional routes, the creation of pain clinics have been developed by most areas across the country to try to support patients with their management of persistent and chronic pain. Analysis of these pathways over many years has now shown limited benefits for the majority of patients attending secondary care pain clinics when it comes to long term behaviour change and symptom improvement.
Pure physiotherapy has been working in primary care delivering first contact musculoskeletal support since 2016. We see over 55,000 patients per month with musculoskeletal problems and around 50% of these have persistent pain and chronic musculoskeletal issues. This has led us to develop a primary care focussed persistent pain service. This service is targeted at people who attend primary care with persistent pain, with the ambition of addressing risk factors earlier.
Our comprehensive modular pain service is based on individual patient needs to facilitate long term, meaningful change. Our key focus is to empower people to manage persistent pain in a way which allows them to have control and ownership of the challenges they may face. We work collaboratively to develop progressive strategies through coaching, education and a variety of interventions all focussed on maximising individuals’ resilience and ultimately happiness.
The Pain Challenge
Chronic pain affects up to 50% of the UK (BMJ 2019) and persistent musculoskeletal pain takes up to 30% of a GPs caseload (HEE 2020). The data we see from our own primary care partners mirrors this national data view of persistent pain when it comes to musculoskeletal problems. With increasing waiting lists for secondary care pain services, and stretched budgets across the NHS, patients suffering with persistent pain often rely upon primary care and can be seen as high frequency users of primary care services. Unfortunately, due to the complex nature of persistent pain, the limited time available in primary care means that the general practice services are frequently unable to effectively support these patients to reduce their dependency on medications, interventions and repeat attendances.
Primary care pain challenges
- Limited GP time to support this patient group
- Long term condition (LTC) pathways often have long waits and highly variable outcomes
- Higher frequency of front-line visits (between 7-10 per annum)
- Associated health impacts with mental health, obesity metabolic health challenges and increased lifestyle risks for other health issues
Our Long-term Pain Service
Individuals with persistent pain are far more likely to struggle to find reliable employment, are more likely to have multiple comorbidities, experience challenges with social isolation, depression, anxiety, obesity and associated health impacts. Behaviours and beliefs of this patient cohort are often ingrained and difficult to influence.
We have developed a specialised team of health and wellbeing coaches to deliver a bespoke and individually compiled pain programme. We have found that by developing a team of expert health and well-being coaches, we can work collaboratively with this patient cohort to challenge some of the negative beliefs and gradually create positive behaviour change which is sustainable and has wide reaching impacts both in the short and long term.
Flexible Service
Each PCN/organisation has their own specialist primary care pain management team, allowing them to understand the local nuances of geography, socioeconomic differences and local environmental challenges. We have found getting to understand the local population really helps to enhance the impact of the support we can provide.
Integrated Approach
Integrating with ARRS and other roles, local health and community services to strengthen primary care teams. Although this service is not a social prescribing service there is significant overlap and inevitably for us to deliver a quality coaching support to change long term behaviour in a positive way. It is important we link with other services and roles within primary and community care to facilitate patients access to appropriate on sometimes ongoing support outside of purely NHS and medical focus services.
Improve Wellbeing
Optimising and maintaining wellbeing and quality of life for our patients. Our ultimate focus is to improve self-management and the well-being of the people that use our service. We collect data and feedback from each service user to demonstrate impact and are constantly evolving our service to give the maximum benefit to our primary care partners and the patients that use the service.
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A Fully Integrated Service
- We collaborate with and enhance existing roles (e.g. social prescribers, mental health practitioners, community link workers and clinical pharmacists).
- We add demonstrable value to patients presenting with long term conditions.
- Expert assessment and individualised goals and care plans, with clinical oversight as stipulated by the GP contract, with experts musculoskeletal and pain specialist physiotherapists and medical professionals.
- Empower patients to be more confident and facilitate self-management.
- We complement existing healthcare and community services.
- Accept referrals from all partners in primary care, allowing meaningful and positive internal referral to reduce pressure on other practice staff.
- Self-referral pathway encouraged.
- Integration with local community services (such as walking groups and social groups).
- In line with 2021 NICE Guidelines to reduce the burden of long-term conditions in primary and community care.
Read pain service PCN and patient testimonials:
Our Focus
- To support the deprescribing of opioids and gabapentinoids targets for Primary Care.
- To utilise FCPs and specialist Health and Wellbeing coaching to integrate with local PCN staff and clinical pharmacists.
- NICE guidelines support health coaching approach to long term conditions.
These programmes work well when combined with First Contact Physiotherapy, health and well-being coaches, social prescribers, and clinical pharmacists. We help to coordinate and integrate these existing services and demonstrate the impact on patients back to the PCN and practices.
Read our Pain Case Studies:
Goal Related Outcomes
We use a combination of patient reported and validated outcome measures. This allows us to measure improvement specific to the patients individual agreed goals. Including:
- The patient specific functional scale
- The pain self-efficacy questionnaire (PSEQ)
- Medication review and analysis
- Patient interviews and feedback
- Monitoring GP surgery attendance
By collecting reliable outcome measures we’re able to support primary care to demonstrate the impact and create a sustainable service for their patients. Several of the primary care organisations we partner with will utilise this data and outcome information to create business cases to present to integrated care boards to draw down appropriate funding to support their patient cohorts more effectively.
The Results
The PSEQ is a 10 item questionnaire that measures confidence in performing activities while in pain. It is a valid outcome measure for patients with persistent pain and is well suited for chronic pain settings (Dube MO et al, 2021).
Pre-pathway
28.33
PSEQ Initial (mean)
Both mean and median scores started at under 30. This demonstrates:
- Poor resilience
- Absence from work
- Increased dependency on medical intervention
- Decline in functional ability
Post-pathway
44.61
PSEQ Final (mean)
A score of 40+ indicates:
- Improved self resilience
- Increased likelihood of return to work
- Better self-management of pain symptoms
- Maintenance of functional gains
Read our Pain Patient Resources:
GP Feedback
“Since adding the service to our PCN we have seen a great improvement in patients’ ability to manage their own health issues more effectively. I genuinely think that, with time, having access to this service will have a long-term impact on improving the lives of many of our most vulnerable patients.”
Dr Small – London
Patient Feedback
“Because of the guidance and coaching from the pain management service, I’m coping with my pain in a much better way, seeing positive changes both physically and mentally, and adopted a new positive mindset. At the start of the programme, I was struggling to see how my pain would get better after having it for so long, but having open conversation and exploring realistic possibilities has allowed me to make changes for the better. My aim at the start of the programme was to be able to get back doing the things I enjoyed before this pain became an issue. I’m now more active, walking more freely, in less pain, and trying more things to make positive changes.”
“I would like to thank you for the incredible support you have given me. You have helped me through one of the most difficult times of my life, when I doubted myself and my ability to move forward. With your support I have accepted my sight loss and looked towards a future for the first time. Your listening skills and empathy are second to none, with your encouragement I once again believe in myself and my ability to cope with my sight loss. I would highly recommend this service to others, it has helped me cope with extreme pain and find the strength to live my life. Take care Kady, I will never forget the impact you had on my life x.”