Agenda item

(To receive a report from NHS Lincolnshire Clinical Commissioning Group, which provides the Committee with an update on the Community Pain Management Service.  Sarah-Jane Mills, Chief Operating Officer, West Locality, Lincolnshire Clinical Commissioning Group and Tim Fowler, Assistant Director, Contracting and Performance, Lincolnshire Clinical Commissioning Group will be in attendance for this item)

The Committee gave consideration to a report from the NHS Lincolnshire Clinical Commissioning Group (CCG), which provided an update on the Community Pain Management Service (CPMS).

The Chairman invited Tim Fowler, Assistant Director of Contracting and Performance, NHS Lincolnshire Clinical Commissioning Group and Sarah-Jane Mills, Chief Operating Officer (West Locality), NHS Lincolnshire Clinical Commissioning Group, to present the report to the Committee.

The Committee noted that the planned restoration of waiting times to pre-Covid-19 levels for the end of December 2020 had slipped and that the CCG was working with the CPMS to ascertain when waiting times were expected to return to more normal levels.  Details of the current CPMS face to face service was provided on page 30 of the report. 

It was noted that the CCG were continuing to work with the CPMS to ensure that comments received from the recent patient satisfaction surveys were addressed through review and action.  It was noted further that eleven complaints had been received during Quarter 3 2020, with nine of the eleven complaints on clinical treatment in relation to the injection pathway.  Lack of access to injections had also been a common theme in patient satisfaction surveys, this matter had been previously been considered by the Committee.  The Committee was reminded that this was largely linked to the approach supported by guidance to reduce injections and to encourage patients to use other approaches to manage their pain where appropriate.  It was highlighted that the CPMS had started to work to improve shared decisions between patients and clinicians with the aim of improving understanding on injections and to lessen the feeling of a one size fits all approach.

Appendix 1 to the report provided details of the KPI performance from April to December 2020; and Appendix 2 provided details of the Lincolnshire Clinical Commissioning Group Opioid prescribing summary data from November 2015 to November 2020 for consideration by the Committee.

The Committee was advised that there had been significant progress made in reducing the number of patients on high dose opioids.  It was highlighted that the CPMS had in place a number of initiatives to support awareness of and reduction in opioid use, details of which were shown on page 33 of the report.

In conclusion, the Committee was advised that waiting times would be recovered as the roadmap to recovery was implemented by the government; that actions were being taken to improve the performance of the KPI's that were below target; that the CPMS was going to improve better shared understanding of decisions between patents and clinicians; and that the CPMS would be continuing to reduce opioid use for chronic pain.

During discussion, the Committee made the following comments:

·       That some CPMS patients had felt isolated as they had not received any contact or support; and with injections being postponed concerns were expressed to the effect this was having on each patient's mental health.  The representatives present agreed to take up the issues raised with the CPMS;

·       The need for better communication between CPMS and patients;

·       The need to allow time for existing users of the service to adapt to the new service, as those patients who were physically dependent needed time to change.  An acknowledgement was made to the points raised and for better management of the transition from one service to the other.  There was also an acknowledgement that in some cases there needed to be a rebalancing of need.  The Committee noted that the CCG and clinicians were reviewing individual cases to have a better understanding, in line with NICE guidance;

·       How the use of opioids in Lincolnshire compared with other CCG areas.  The Committee was advised that this information would be made available to members of the Committee;

·       When the CCG would be expecting an action plan to make a difference to the performance of KPI 5; and whether this information could be shared with the Committee.  It was agreed that an action plan from the last contract meeting was available and would be shared with the Committee;

·       Did the CCG know how many patients had given up on the NHS community pain management service and had sought private treatment?  The Committee noted that this information was not known;

·       Whether clinicians, such as consultants had full decision-making power on treatments they provided to patients or whether they had to gain authority before administering.  The Committee was advised that there were no treatments within the CCG's approval policy if listed.  It was noted that for some treatments, i.e. spinal injection, treatment would only be provided after being reviewed by a funding panel.  The Chairman requested further information in this regard.

RESOLVED

1.    That the report from NHS Lincolnshire Clinical Commissioning Group on the Community Pain Management Service be noted.

2.    That a further update on the Community Pain Management Service be received in six months, when the Committee would be looking to improvements to the key performance indicators, which were currently underperforming. 

3.    That information relating to how the use of opioids in Lincolnshire compares with other CCG areas; a copy of the action plan from the last contract meeting concerning the performance of KPI 5; and information concerning the time taken to make decisions relating to treatments outside the CCG approved policy be made available to members of the Committee.