Musculoskeletal Medicine in Practice

Abstract

Objectives To provide a rapid access treatment facility in the primary care setting for patients with acute low back pain. To implement the recommendations of the Clinical Standards Advisory Group for back pain (CSAG).Design A pilot scheme was initially run with a treatment centre in each of Plymouth’s three locality care groups (LCGs). 12 months funding was obtained from each locality’s development funds. All GPs in the area were invited to refer patients according to an agreed protocol and targets for waiting times were set. Each centre was run by a practitioner with special skills and experience in the management of back pain.Setting Consulting rooms in three general practice surgeries with facilities for carrying out examinations, spinal manipulations, acupuncture and caudal epidurals.Participants The protocol for referral included patients between 18 and 60 with symptoms of six weeks duration or less who were not making progress and who would otherwise have been referred to secondary care.Results In the pilot year, 651 patients were referred and 92% were seen within two weeks of the request. 50% were off work at the time of referral. At discharge, 72% were more than 70% improved and only four percent required further referral, in the majority of cases for a neurosurgical opinion. The average cost per patient treated was £91, considerably less than hospital outpatient treatment.Conclusion A rapid response service for patients with acute back pain has been adopted by Plymouth’s PCT. This service has shown itself to be both effective and economical. A multidisciplinary sub-acute service was added after 12 months. The acute and the sub acute clinics together with the existing hospital pain clinic, provide a seamless service for patients with back pain that satisfies the principal recommendations in the CSAG (HMSO 1994) report.