Delivering as a CCG

Pain services

Current position

The current pain service is very fragmented with different services being provided in different areas. There is a lack of clarity as to which service is most appropriate to meet patient needs. Within NUH there is a pain management service and a separate back pain service, as well as outpatient appointments for joint injections and consultant clinics.

Case for change

A review of the evidence of the clinical and cost effectiveness of interventions currently used has been conducted by Public Health colleagues and in conjunction with the Core Standards for Pain Management in the UK (Faculty of Pain Medicine Oct 2015), NICE guidance and SIGN guidance. This provides a clear way forward for the service to improve  the consistency and quality of services for patients across the the area.

Proposal for community based pain services

It is proposed that pain management services should be delivered through a three level system:

  • Level One – primary care services from GPs, community pharmacists, community psychological therapies, pain self-help organisations/groups and community based physical and psychological therapies.
  • Level Two – community based services offering a multi-disciplinary team approach to pain management or CFS care including specialist physical and psychological therapies, evidence based interventions such as exercise programmes and access to self-help resources.
  • Level Three – secondary care service for patients requiring surgery or procedures that require an acute care setting. Referrals to this service must be in line with the agreed service pathway

The Level Two service will consist of a multi-disciplinary team that can assess all referrals, and manage patient’s physical, psychological and social needs associated with pain. It will ensure patients experiencing chronic pain are appropriately managed in a community environment. Patients requiring secondary care can be referred into an appropriate hospital setting when they need specialist interventions and will then be transferred back to a community setting (if necessary) once Level Three intervention is complete.

The use of a “never discharged but not followed up” policy will be adopted to enable long term follow up of patients at set points as agreed with the patient. This enables the patient to self-refer back into the service directly when agreed changes in their condition are noted or if the patient/carer/family need to seek advice to assist in self-management.

All patients will have a comprehensive treatment plan which uses standardised language and terminology to enable colleagues across services to talk to the patient regarding their care plan using common language that everyone understands. The treatment plan will include a clear explanation of the circumstances that require them to re-engage with the service, how to manage flare ups and the importance of contacting the service at these times in preference to primary care or attending ED where possible

Reducing the fragmentation of the current pathway for patients with chronic pain and ensuring more standardisation in the treatment of patients will reduce duplicating or overlapping service provision and consequent extra payment for the same or similar service. This will help address the financial challenges facing the health and social care system.

Tell us what you think

The engagement period for this service review has now ended.  For an update on the decisions on services, click here.


If you would like a paper copy of the You-said-we-did Summary,  please call 0800 028 3693 (option 2)

For further comments, please send your comments to the Patient Experience Team on or write to:


Patient Experience Team

South Nottinghamshire CCGs

Civic Centre

Arnot Hill Park




If you would like a paper copy of the You-said-we-did summary please call 0800 028 3693 (option 2)


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