An evaluation of the implementation of a multidisciplinary persistent pain service in the inner London Borough of Tower Hamlets

Aim The aim of this study was to evaluate the implementation phase of a multidisciplinary persistent pain service (PPS). Background A multidisciplinary PPS was established in January 2008 at the London Borough of Tower Hamlets. Referral is made into the service via general practitioners (GPs). Patients see an appropriate mix of clinicians; they include a pain specialist, physiotherapists, an occupational therapist, psychologists and/or health and advice worker. Method Data were collected by using patient questionnaires, monthly activity reports from clinicians, service administration and patient and staff interviews. Findings Service activity steadily increased to full capacity after nine months. Eighty-two percent (31/38) of Tower Hamlets GP clinics referred patients to the service; the referrals were appropriate. The discharge rate at nine months was 5% while 9% failed to attend or declined to attend. Patients saw on average two clinical specialities, post multidisciplinary team discussion and had four appointments. The majority of patients were female (89/144, 62%); between 41 and 60 years old (55%), unemployed (79%), received disability or incapacity allowances (28%), had pain for more than 10 years (27%) and were not fluent in English (37%). The patient and practitioner interviews highlighted: difficulties keeping track of patients as they progressed through the service, inconsistent administration that affected patient satisfaction, lack of understanding of treatment process and plans and cross discipline learning benefit for staff. Conclusion Implementing a multidisciplinary service requires forethought, and regular monitoring to ensure efficiency. For multidisciplinary services we recommend: GP education, clear delineation of responsibilities between staff, efficient systems for tracking patient progress, regular staff meetings and jointly negotiated treatment plans that patients can keep.