GPs in the pathway: Role and resources
Through funding from the Academic Health Science Network for the North East and North Cumbria, NHS South Tees CCG and NHS Hambleton, Richmond and Whitby CCG will be the early implementers of the North of England Regional Back Pain and Radicular Pain Pathway. The learning and approaches used from this implementation will be shared with the other CCGs rolling out the pathway. On-line information supporting the implementation will be available from http://www.darlingtonccg.nhs.uk/regional-back-painprogramme/ Wave 1 CCGs (NHS Hartlepool and Stockton-on-Tees and Darlington CCGs) will implement the new pathway from December 2015.
The main service providers are working with the project team to clarify current activity baselines and understand the impact of implementing the service changes. NHS Newcastle Gateshead CCG are exploring being part of Wave 2 with potential implementation taking place August 2016 and other areas will be implementing the pathway within Wave 3 between August 2017 and March 2019 unless they express an interest and plan to implement at an earlier point. NEQOS are undertaking data analysis of current baseline information that will inform discussions with CCGs and evaluating the programme. July 2015 (3) GPs in South Tees heard about the implementation of the pathway for the South Tees area at their last protected learning session in May.
This included their Clinical Radicular Pain Nerve Root Block – Direct Access The North of England Regional Back Pain and Radicular Pain Pathway ensures that patients with radicular pain (also known as Sciatica) have direct access to Nerve Root Blocks (Transforaminal Epidural Injections) if required. Nerve Root Blocks are used in the diagnosis and treatment of radicular symptoms. Lumbar spinal stenosis (central or foraminal) and disc herniations can induce nerve root irritation and inflammation. Inflammation of the nerve root induces neurophysiologic and histologic changes that can result in radicular symptoms.
The Nerve Root Block instils medication along the affected nerve root and into the anterior epidural space at the site of inflammation. The use of local anaesthetics and corticosteroids reduces the nerve root irritation whilst increasing intraradicular blood flow. The procedure is carried out as a day case using state-of-the-art fluoroscopic equipment. Patients will be required to give written consent prior to the procedure and will have a period of recovery prior to discharge to their usual place of residence. role and resources available for for staff and patients (details overleaf). This early focus on education sessions for GPs and clinicians on the Back Pain and Radicular Pain Pathway is key to implementation and aims to ensure full engagement and the success of the pathway. The workshop gave attendees the opportunity to put questions and the afternoon was supported by the Cumbria and North East Academic Health Science Network and the North East Quality Observatory System. All the presentations are available from the webpage set up to support the programme.