Back to the old drawing board

Health workers in Brighton and Hove have spent the past year reassessing how they deal with patients.

The treatment has been very effective. The length of time patients with chronic back pain have to wait for assessment has been cut from more than two years to three months.

Just 12 months ago, patients faced long waits for treatment for chronic back pain. They would be referred to a number of specialists who were not necessarily appropriate to their needs.

Nearly half the patients referred to the chronic back pain clinic at the Royal Sussex County Hospital in Brighton would fail to turn up for their first appointment and information on how they could cope with back pain in the interim was also inadequate.

Nationally, the government has invested in a series of educational initiatives to reform orthopaedic care and share good practice.

In Brighton and Hove, a group of local clinical staff and managers worked together to transform the back pain service: Urgent patients are now seen in a triage clinic at Hove Polyclinic within two weeks of seeing their GP.

They are assessed by physiotherapists who have received specialist training so they can ask for investigations such as MRI scanning, x-rays and blood tests which previously only a doctor was allowed to do.

As a result, waiting times have been reduced from 27 months to three months, which means patients are now more likely to attend.

Now, less than one in five miss the first appointment. GPs have a new information leaflet to give to patients which sets out ways to cope with their condition.

Patients can also be referred to new physiotherapy classes which teach pain management. Treatments are based on the latest clinical evidence.

The reforms were led by Brighton and Hove City Primary Care Trust (PCT) and were brought about without any additional costs to the NHS locally.

Chris Mercer, a physiotherapist who helped co-ordinate the work, said: "It is vital patients with back pain get rapid treatment. They need to be seen in the right place, at the right time and by the right people.

"Evidence shows 50 per cent of people who stop work for more than six months because of back pain, will never return to work again and after 12 months, that rises to 98 per cent.

"Clearly, there are massive social and personal costs as a result of back pain so getting it right is crucial."

Steve Matthews, 44, from Brighton, waited for more than two years for treatment before the new system was in place.

He was among the first to experience the new physiotherapy exercise classes, which help patients overcome the impact of suffering from back pain for a long period.

He said: "The outcome of doing the course was very positive. I went twice a week for four weeks.

"Each time was for an hour where we would do set exercises for ten minutes each - things like sitting on a chair, crossing your arms and standing up. For most people who go to the classes, to do ten minutes of exercise is a major achievement.

"It helps you find out how to manage your back pain. It gives you confidence. There was a time when I couldn't even stand up. When things are so bad for so long, you get out of the belief you can do simple things. You get into a mindset."

"Working within a group also helped. If you are on your own, you can be less likely to get on with the exercises but if you are working with other people, there is more of a pressure to carry on. It helped a great deal."

Eight out of ten people will suffer from back pain in some form during their life.

At any one time, about a quarter of people will have lower back pain, most of which will settle on its own without treatment.

Nine out of ten people who have back pain will feel better in about six weeks.

People who are fitter tend to recover more quickly. It is best to keep active when you have back pain.

Studies show prolonged rest is not helpful and may cause more problems. Sufferers should not take to their bed for more than two days.