IPASS in West Berkshire

Improving the co-ordination of care for people with chronic pain


Summary

The Integrated Pain and Spinal Service (IPASS) in West Berkshire aims to support patients in managing musculoskeletal (MSK) pain and reduce unnecessary referrals to secondary care. Since its inception in September 2015, IPASS has provided timely access to a multi-disciplinary team of specialists, delivered personalised treatment plans, and demonstrated the potential to be cost-saving when compared to current service standards.
  • Average waiting times have been reduced to <4 weeks, compared to >6 months prior to IPASS 
  • IPASS is expected to be cost-saving from Year 2 onwards bringing in a net saving of £111,455 
  • 100% of patients feel ‘much more confident’ in managing pain after attending an IPASS session 
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The Challenge

  • The most common source of pain is musculoskeletal (MSK) and the goal of treatment is to successfully manage these conditions to improve functioning and quality of life.
  • Due to its complex nature, taking a bio-psycho-social approach is essential, requiring a full spectrum of services in primary, secondary, and community care.
  • There is currently limited service provision in the local health economy to manage these conditions successfully and in the past 5 years, the financial burden of MSK pain has increased 20% due to rising outpatient attendances across a number of specialist services.

The Solution

  • In 2014 clinicians from the Community Trust (Berkshire Healthcare Foundation Trust), acute Trust (Royal Berkshire Foundation Trust), primary care physicians, commissioners and patients came together to address the problems of increasing out-patient activity for pain related conditions and the associated management of them.
  • The recommendations from this group led to the development and enhancement of the already established Community Spinal Service into the Integrated Pain and Spinal Service (IPASS).
  • The purpose of the IPASS is to:
    • Provide appropriate assessment and treatment earlier on in the patient journey and to avoid duplication and delay of appointments/referrals.
    • Offer a range of strategies including back and pain management classes to engage patients in exercise activities and promote self-management.
    • Reduce secondary care attendance to create a cost-effective service.

Service Pathway

  • All GP referrals for patients with general pain or spinal pain (excluding ‘red flag’ patients) are now referred to the Pain or Spinal areas of IPASS instead of secondary care.
    • Patients with general pain for longer than 3–6 months with no medically treatable pathology found after investigation are referred to the pain management part of IPASS
    • Patients with acute/sub-acute spinal symptoms who may require further investigation or possible medical/surgical intervention are referred to the spinal part of IPASS
  • Therapists specialising in pain management and spinal conditions triage patients to the most appropriate healthcare professionals either in the community or in secondary care for assessment.

Service Performance and Outcomes

  • Prior to IPASS, waiting times were in excess of 7–9 months for 1-to-1 physiotherapy and psychology assessments, and 6 months for a group programme. The average waiting time across multiple services is now 3.4 weeks and 92% of patients are seen within 6 weeks.
  • The effectiveness of IPASS has been established through marked improvements in outcome measures relating to patient wellbeing and quality of life, including the Chronic Pain Acceptance Questionnaire and Work & Social Adjustment Scale

Financial Performance and Outcomes

  • An investment of £343,351 was required in Year 1 to establish IPASS as a new service and continuing operational costs are expected to be £515,311 per year.
  • It is forecast that IPASS will reduce multiple attendances linked with pain by at least 50% each year and that related day case procedures could be reduced by 5%. As a result, IPASS is expected to be cost-saving from Year 2 onwards bringing in a net saving of £111,455 per year.

Patient Focus and Satisfaction

  • IPASS has a focus on self-management for patients, and a key part of the approach is identifying patients at risk and setting personalised goals to improve outcomes.
  • Feedback on the service has been very positive with patients remarking that the group sessions were very helpful in learning skills to manage pain. Everyone agreed that they had taken away something of lasting value.
  • When asked during a survey how confident they now feel in managing pain, all respondents agreed that they are now ‘much more confident’ having attended an IPASS session.

Commissioning Implications


The IPASS in West Berkshire is an example of commissioning best practice in rheumatology and meets a number of priorities for commissioners, clinicians and patients:

 

  • Active support for self-management – IPASS has a strong emphasis on educating patients in order to encourage the self-management of the symptoms of pain.
  • Care Coordination – the IPASS service coordinates care across a multidisciplinary team, addressing a wide variety of patient needs, and prevents unnecessary referrals into secondary care.
  • Addressing Mental and Physical Needs – the IPASS service has a strong emphasis on psychology and effectively addresses the mental and physical needs of patients.

The service has only recently been established in West Berkshire and is considered an emerging best practice model for the multi-disciplinary management of MSK-related pain conditions. Based on the available data and forecasted outcomes, IPASS has the potential to offer timely and effective treatment of pain whilst reducing expenditure.


Service diagram