The NHS North Kirklees CCG wishes to commission a Tier 2 Chronic Pain Service for people with long term pain that:

— Improves health and quality of life;

— Is evidence based and patient centred;

— Is sustainable and provides value.

This service will cover all types of pain with duration greater than 3 months in the adult population, with the exception of current Cancer Pain. This service broadly follows the Department of Health 18 week Chronic Pain Pathway, with some local variation (see Chronic Pain Pathway NHS Kirklees 2010).

The service spans part of the pain pathway in that it will link closely with primary and secondary care. The service shall:

— Provide appropriate evidence based assessment and treatment for pain and improve physical and mental symptom control e.g. sleep, depression.

— Conduct person centred health needs assessments (Bio psychosocial) for all pain conditions present longer than 12 weeks for impact of pain on health functioning and employment.

— Assess the patient within 8 weeks of referral into the service from general practice (or 4 weeks from when the patient opts into the service by returning their initial assessment questionnaire).

— Produce a patient led management plan following assessment.

— Maintain or improve physical functioning throughout the duration of the condition, where appropriate offering referral to appropriate physical activity programmes.

— Identify and manage depression, anxiety and other psychological distress.

— Prevent weight gain, obesity and minimise other related health problems that impact on a long term pain condition, such as heart disease, depression, weight management (See JSNA, 2009).

— Enable self management; key skills and access to self care resources to build increasing confidence to manage the condition.

— Implement effective evidence based treatments, including recommending medication change, or appropriate interventions where indicated.

— Ensure assessment of medication use at every attendance including patient adherence, % symptom relief and adverse events to the patient to maximise their benefits and reduction of harm.

— Address employment issues such as supporting people to stay in or return to work when their absence from work is linked to their condition.

— Manage recurrence or flare ups in the pain conditions by recurrent input and appropriate reviews by clinicians.

— Enable patient held clinical records to contribute to the seamless delivery of the services.

In order to achieve these standards, there will be a requirement for health practitioners to be trained to an appropriate level of competency for delivery of pain management at each step of the pathway.