Privatisation of Greater Huddersfield pain services makes patient livid

A Huddersfield patient is “livid” after being referred by their GP to a pain clinic run by a private company, Pain Management Solutions.

The patient, who has been receiving spinal injections for pain management for many years after all else had failed, received an appointment from Locala saying she had chosen the Pain Management Solutions clinic – which she hadn’t. She wanted to go and see her usual consultant.

The patient, who wishes to remain anonymous, said,

“I started with a pain clinic in Huddersfield several years ago. So I’m not very happy with my GP for sending me down this route again. I’m so cross and upset that other companies are taking over NHS patients unbeknown to them.”

Greater Huddersfield GPs have to send patients to Locala’s Musculoskelatal Hub

A GP from the patient’s surgery has said that GPs now HAVE to refer patients who need pain treatment to Locala’s Musculoskelatal (MSK) Hub.

They fully agreed with the patient that this type of referral should not be happening and advised the patient to complain to the Clinical Commissioning Group about it.

On Monday 24th April Locala briefed GPs that from then on, they are to direct all referrals for Musculo Skeletal (MSK), Elective Orthopaedics and MSK/Chronic Pain to the new MSK Hub using the NHS Electronic Referral Service (ERS).

Locala’s GP briefing says that when GPs make a referral to the MSK Hub, a Triage Appointment will be booked for a multidisciplinary team to review the referral and direct it to the most appropriate service.  Referrals not requiring hospital intervention will be triaged into specialist community services as appropriate.

In this case, the patient was triaged into Pain Management Solutions. The initial scheduled appointment was only a telephone appointment, which did not materialise at the planned time and date. When the patient phoned to ask why, Pain Management Solutions said this appointment had been cancelled. They hadn’t notified the patient.

Then a few days later Pain Management Solutions sent another letter telling the patient they had to go to a Huddersfield GP surgery for another appointment.

Who are Pain Management Solutions?

In June 2016, Pain Management Solutions was acquired by InHealth Group –

“a privately owned, UK based company…with a focus on continued and sustainable growth.”

InHealth Pain Management Solutions have not yet been inspected by the Care Quality Commission.

Treatment restrictions

The patient has not been able to have their normal spinal injection treatment that both the patient and GP know is needed – as the patient has been down every other possible treatment route and paid hundreds of pounds over the last 10 years on alternatives i.e. Chiropractor, physio, acupuncture etc.

The Pain Management Solutions leaflet says that pain injections into the spine and other areas are available, if the contract they hold from the Clinical Commissioning Group permits that. Otherwise available treatments are limited to attendance at a pain management programme in groups or alone, and medication recommendations to the patient’s GP.

Greater Huddersfield Clinical Commissioning Group, which gave Pain Managament Solutions a contract at the end of 2015 to run specialist Community pain clinics in Greater Huddersfield leisure centres , said:

“Following the publication of NICE Guidance (NG59) in November 2016, Greater Huddersfield CCG no longer routinely commissions therapeutic spinal injections for the management of non-specific lower back pain/sciatica in people aged 16 and over.
The Guideline Development Group (GDG) concluded that there was no consistent good quality evidence to recommend the use of repeat spinal injections for the management of non-specific lower back pain with minimal evidence of benefit from injections.
There are some exceptions to this policy which are detailed in the CCG’s commissioning statement.”

The commissioning statement says “a small cohort of patients is likely to benefit from therapeutic spinal injections” which may be suitable for urgent relief of severe, acute spinal pain, and for selected patients as recommended by a Specialist Pain Clinician,

“when pain prevents the patient from engaging in a comprehensive self management programme.

“In these cases, the CCG will routinely approve up to 2 injections to allow the patient to engage in a structured pain management programme. If there is good clinical evidence to support further injections, then an application for approval should be made through the Prior Approval/Individual funding request process.”

The Pain Management Solutions appointment letter also states that they aim to complete this “episode of care” within six months. This for a patient who has been in need of pain management for 10 years.

The patient has had to order further pain relief from their GP.  This should not be long term and is also a waste of NHS money. The tablets are not needed after having the spinal injection, but as the time scale of this latest episode is dragging on there is no other option.

Patient self-management

Dr Steve Ollerton, the Greater Huddersfield CCG Governing Body Chair, says Pain Management Solutions focusses on:

“self-management techniques and treatments designed to help people regain control of their life.”

Multidisciplinary teams at Pain Management Solutions clinics include clinical psychologists and cognitive behavioural therapists as well as doctors, nurses, physiotherapists and occupational therapists.

A study of chronic pain management (Pain Manag Nurs. 2013;14(3):161-171.)  says that

“studies highlight the stigma associated with adopting a psychologic framework for understanding pain and the impact this can have in stigmatizing—or discrediting— individuals.”

With its aims of  “reducing referrals, low value clinical interventions, promoting patient self-management,” does the new Greater Huddersfield Clinical Commissioning Group contract for MSK services with Pain Management Solutions encourage the “psychologic framework” – telling patients the pain is in their minds?

The moral core of medicine has always been the relief of suffering, but the Clinical Commissioning Groups, NHS England and the government are making it more about money and returns on investment.

The frustrated Huddersfield patient said,

“I’m not surprised one bit that Dr Ollerton has piped up on this one!

‘Not fit for purpose’, I have read from one of the Pain Management patients and couldn’t agree more. As I am currently being ‘forced’ to use this company, it gets me so angry that these companies are chipping away at our wonderful NHS!”

Cutting costs

The creation of the Locala MSK Hub and the privatisation of pain management services follows the Clinical Commissioning Group’s redesign of Musculoskeletal (MSK) services in Greater Huddersfield.

In 2014/15 the West and South Yorkshire and Bassetlaw Clinical Commissioning Group drew up the specifications for an integrated Musculoskeletal (MSK) clinical assessment and treatment service in Greater Huddersfield, to be delivered through an MSK Hub.

The MSK Hub was intended to triage, assess and provide treatment in the community in order to reduce the use of hospital MSK services, such as pain relief injections and surgery.

This is because of massive “efficiency cuts” to NHS spending, that required £20bn to be cut between 2010-15 and a further £22bn-£29bn (depending on whose figures you trust) between 2016-2021.

The Commissioning Support Unit’s MSK Hub specification  says that:

“MSK services need to radically change to manage and deliver against growing demand…
given this increasing demand, the need to deliver more with less and a continuing reduction in public service funding, the status quo is not sustainable.”

How often have we heard that austerity lie trotted out by the CCGs in Calderdale and Kirklees?

The lack of adequate funding for the NHS is the result of deliberate political decisions by the government, and the public’s astonishing acceptance of them.

The West Yorkshire and Harrogate Sustainability and Transformation Partnership requires NHS and social care spending cuts of £1.07bn by 2020/21, compared with what would need to be spent if current services were maintained.

In Kirklees the required cuts amount to £208m. One of the ways of making this cut is a planned 19% cut in hospital admissions.

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