South East Essex Low Back Pain Pilot Pathway

An attempt to de-medicalise back pain across the Southend area

The STarT Back Tool Scoring System

Total score

3 or less

4 or more

Sub score Q5-9 3 or less Low risk Medium risk 4 or more High risk
Keele University 01/08/07 Funded by Arthritis Research UK

Overview of the Project

Southend Hospital, South East Essex PCT and the local Clinical Commissioning Groups worked together to produce a clinical care pathway for people with low back pain. GPs assessed people with back pain and those with 'red flag' symptoms and signs were referred as usual. GPs actively managed people with non-specific low back pain for 6 weeks. Where GPs then referred people for further treatment, the Keele STarT Back questionnaire was used to assign appropriate levels of Physiotherapy-led care.

behavioural therapist for the high-risk patients. The project had to survive merger of two PCTS and loss of the main PCT commissioning manager involved.

Results
The four primary care sites for low risk patients were established and a cognitive behavioural therapist seconded to the project. Initial data suggest a lower referral rate into secondary care from participating GPs compared to non-pilot GPs. Fewer low risk patients have referred than expected. These findings suggest that GPs are managing patients successfully. The project has led to much closer collaboration between primary and secondary care clinicians. Although final data has not been collected, many GPs would like this pilot to become the standard pathway for back pain management across Southend.

Leadership Challenges
We had to produce an evidence-based pathway acceptable across primary and secondary care. As many GPs as possible had to be involved in design of the pathway, because of their key role in assessment and active management of patients. GPs had to feel selfconfident in active management of patients and the use of the STarT Back triage questionnaire. We had to set up four physiotherapy community venues and redeploy a cognitive

Contact Information
Dr Way Main Wong Consultant Rheumatologist WayMain.Wong@southend.nhs.uk 01702 385616