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Information for GP’s: Hampshire

Musculoskeletal Service for Back and Neck Pain

This service is delivered by Back2Health on behalf of the NHS in North Hampshire.

How can I refer a patient?

Referrals may be made via the Hampshire Backs service provided by North Hampshire Hospitals Foundation trust. For details of referral pathway and referral form please see: https://www.hampshirebacks.co.uk/professionals

Eligibility criteria:

A patient is eligible for referral to the MSK Back and Neck Pain service if they present with primarily back or neck pain with or without ‘referred’ symptoms to the limbs including:

  • Whiplash associated disorders
  • Stiffness and restricted movement
  • Cervicogenic headaches
  • ‘Mechanical’ neck and back pain
  • Degenerative pain
  • Postural related neck and back pain.

NOTE: patients may only be referred into this service with problems to the same area once in 12 months.

Exclusions:

Patients who meet any the following conditions are not appropriate for referral and therefore not covered in this service:

  • Suspicions of serious pathology
  • Patients under 16 years of age
  • Patients who are not registered with a GP in locality.
  • Patients with widespread or non  musculoskeletal pain.
  • Patients who have a primary peripheral limb problem with secondary back and neck pain (e.g. hip or shoulder problems).
  • Women who are over 35 weeks pregnant.

What will patients experience

Upon receipt of a referral we will contact the patient by phone to make an initial appointment. Under Choose and Book patients will contact us as instructed on their print out. It is anticipated that they will be offered appointments within a few days. We have clinics open 8am – 7pm weekdays and 9am -12.30 Saturdays.

Patients will be asked to complete a pre-initial visit questionnaire and may do this online or at our clinics. This questionnaire contains the Bournemouth Questionnaire (BQ), background medical history questions and for those with LBP the STarT Back screening Tool (SBT).

At the first visit patients will have the opportunity to explain their problem and what it means to them. They will have a comprehensive MSK examination. They will be provided with an explanation of their symptoms and where appropriate, treatment will start at this first session.

The service Back2Health provides places strong emphasis is upon patients taking responsibility for their symptoms, and their playing an active role in the treatment.

Those patients with LBP of less than 6 weeks duration and ranked at Low2 risk of enduring pain and disability by the SBT will be given written self help advice and will be placed ‘on-call’ for a month. At 30 days they will be sent an assessment questionnaire containing the BQ and a global impression of change scale. Those making good improvement and satisfied with their progress will be discharged. Those failing to improve may represent for further treatment.

Other patients will be given a written care plan and offered a course of treatment sessions. Our experience suggests most will need on average a further 4 sessions, although up to 9 are permissible in this pathway. Where mild or moderate modifiable psychological barriers (yellow flags) are identified these will be managed by our practitioners alongside physical barriers. If severe non-physical factors are found to be dominating a presentation then referral to, or co-management alongside psychological services will be sought.

At the end of a course of care patients will complete an outcome assessment questionnaire. Those making good improvement and satisfied with their progress will be discharged. Where appropriate others will be offered further treatment possibly with different care.

At discharge patients will receive written advice on preventing reoccurrence and a report will be sent to their referrer & GP.

What are the differences between Chiropractors and Osteopaths?

It is not possible to define a clear difference between Chiropractic and Osteopathy. Broadly Chiropractors focus more on the area of presenting symptoms whist Osteopaths are more likely to include treatment of other parts of the body. Each practitioner has his or her own style of delivering treatment and this individual variation is more distinctive than any difference between the professions. Variation in style reflects the practitioner’s education, training background and experience.

Research has not identified differences in outcomes between care provided by Chiropractors or Osteopaths. The types of care provided by both professions at Back2Health have been found to provide significant and cost efficient benefits over best practice GP care and are in line with NICE guidelines3&4. A Medical Research Council funded RCT reporting in the BMJ concluded that Chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management5.

To discuss this service further of for any queries please contact Jonathan Field on 01730 267434, jonathan@b2h.co.uk.

References:

1 UK Royal College of Chiropractors PPQM & CMQM.

2 Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, et al: Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011, 378(9602):1560–1571.

3 UK BEAM Trial Team 2004, ‘United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care’, BMJ (Clinical research ed), vol. 329, no. 7479, p. 1381.

4 NICE, Savigny, P, Watson, P, Underwood, MR & Guideline Development Group 2009, ‘Early management of persistent non-specific low back pain: summary of NICE guidance’, BMJ (Clinical research ed), vol. 338, p. b1805.

5 Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital out-patient treatment. BMJ 1990;300:1431-7.

Locations from where this service is being delivered:

Alton Health Centre, Anstey Road, Alton, Hants.

18 Cliddesden Road, Basingstoke, Hants

Holmwood Health Centre, Tadley, Hants