North of England back pain pathway NHS Darlington CCG

Low back pain is the largest single cause both of loss of disability adjusted life years and of years lived with disability in the UK. 

There is variation in back pain management across professional groups in the NHS and private sector, often resulting in expensive investigations and ineffective care, leading to poor outcomes and low patient satisfaction.

The North of England back pain pathway aimed to improve the management of patients with low back pain and radicular pain (sciatica) in the North East of England and Cumbria, building on an earlier pilot in South Tees funded by the local Academic Health Science Network.

The pathway begins in primary care, where the person with lower back pain is assessed. They are then either discharged with self-management advice, referred to secondary care, or referred to a Triage and Treat Practitioner (TTP), who decides the next step of the pathway, which can include education, manual therapy and exercise. 

There is also the option to refer to a Combined Physical and Psychological Programme (CPPP), a residential programme that includes intensive exercise, education and help with long-term self-management. 

Evaluation of the pathway at two early implementer sites found significant clinical improvements for patients on the pathway in pain, disability, quality of life, anxiety and depression, in both the TTP and CPPP groups. These improvements were maintained at six and 12 month follow-ups. 

For the pathway to be fully implemented across the regions, there needs to be collaboration across the NHS, with clear lines of accountability and oversight. Designated champions are needed to drive and embed system-wide change, and allow the pathway to become the cultural norm.