Case study summary
Patients in Berkshire suffering high levels of pain have had their wait for a specialist appointment reduced from nine months to just one, saving the NHS more than £200k a year.
Berkshire patients with a range of pain symptoms were unnecessarily being referred to Pain, Trauma and Orthopaedics, Neurology and Rheumatology outpatients for further tests and consultant appointments, causing inconvenience to themselves and extra cost to the NHS.
As a result of primary, secondary, community care, GPs, consultants, radiologists, physiotherapists, psychologists and commissioners coming together with expert patients the numbers of patients having appointments at two or more of the four specialties dropped by a third.
Before the new system began, waiting times for outpatient appointments were between seven and nine months. The average waiting time is now around 4 weeks, with 92% of patients seen in six weeks.
Over seven months in the year, appointments fell from 3,335 in 2015/16 to 2,814 in 16/17 to 2,016 in 17/18 with savings of £138,716 in 2016/17 and £264,760 in 2017/18.
Berkshire West CCGs worked with Royal Berkshire NHS Foundation Trust and Berkshire Healthcare NHS Foundation Trust to develop the Integrated Pain and Spinal Service (IPASS) which highlights the benefits of partnership working in the Accountable Care Systems (ACS’) now embedding across the NHS.
Dr Rupert Woolley, North and West Reading CCG GP and Planned Care Clinical Lead, said: “Making sure patients at risk of chronic pain are identified early and referred to our multi-disciplinary team of specialists for a personalised treatment plan is key to making this work.
“Setting personalised goals to improve their quality of life is very important and monthly meetings and regular touchpoints are held between members of the multidisciplinary team meaning issues can be resolved quickly.”
Patients are now streamlined through the Integrated Pain and Spinal Service (IPASS) rather than through multiple pathways which means fewer admissions to hospital and fewer multiple attendances to secondary care or back to IPASS, improving outcomes and care.
Patient Godfrey Pankhurst, said: “The most amazing thing about my first contact with IPASS really was the care and time given to me. I ceased to be an NHS number but became a person who they clearly cared for and want the best for you.
“I wouldn’t really feel there’s anything wrong for me now – that’s the most amazing position to be in. To be free of the spinal pain has just opened up driving, shopping and being with the grandchildren, all those things have returned and with a joy as well.”
Dr Antoni Chan, Rheumatology Consultant at the Royal Berkshire Hospital who led the project through its development said: “It is estimated that 14 million people live with chronic pain in England alone. Before the collaborative service was launched, the care of patients living with chronic pain could be disjointed, with each provider managing their own episode of care in isolation to other healthcare colleagues. This often led to duplication of information and multiple visits for patients.
“The formation of the Berkshire IPASS has meant that patients are now assessed and receive the most appropriate care earlier on in their treatment plan. The service also offers a range of strategies including back and pain management classes to engage patients in exercise activities and promote self-management of their condition.”
Patient Lindi Bothar, said: “For me to come to the sessions and hear what other people are going through – if I can cope with it and make it work and feel better about it, it gives you hope.”
Berkshire West Clinical Commissioning Groups, leading the change, aim to reduce multiple attendances linked with pain by at least 50 per cent each year and hope for a potential reduction in related day case procedures of five per cent. IPASS is expected to save £111,455 a year.
Joe Smart, Transformation Lead for Berkshire West CCGs, said: “This service is an excellent example of true transformation in the NHS where waste and inefficiency is removed and the needs of the patient are put at the heart of the service redesign.”
CCGs across England are now looking to replicate this service which has won a British Society of Rheumatology (BSR) award for innovation and been shortlisted for a Health Service Journal Award.
The BSR have further funded an IPASS toolkit of how the service has been able to deliver and be successful and what processes were taken are fully explained.
IPASS in Berkshire West supports patients in managing musculoskeletal (MSK) pain and reduce unnecessary referrals to secondary care.