• Led by Bournemouth University and partnered by BackCare, NHS Bournemouth and Poole, NHS Wiltshire, and the Institute of Musculoskeletal Research and Clinical Implementation.
  • Ran from 2007 to 2010.
  • Focused on back pain and addressing the inconsistencies in treatment across primary care.
  • The team worked with GP practices to learn how to apply evidence based practice to real life situations.

Managing back pain remains a major problem for the NHS – there are inconsistencies across primary care in how it is treated and variations in applying best practice. This leads to inappropriate referrals, huge costs, delays in treatment, chronicity and disability.

This project aimed to meet the learning needs of GP practices in treating back pain, providing them with specific information about current research and exploring and exposing myths around pain relief for back care.

This project addressed the ‘learning needs’ of nine GP practices, and involved all practice team professionals working closely with patient representatives. Through a series of workshops, practices discussed evidence about back pain, including current clinical guidance and knowledge around quality improvement. Practice teams exchanged ideas and used evidence to inform their improvement plans. They also introduced and tested changes using PDSA cycles and were supported on site by an improvement facilitator.


  • Sustained improvements were noted one year after the workshops, with GP practices doing things differently and a radical shift in their approach to engaging with patients.
  • The project helped practices become more skilled at recognising back pain, providing guidance on how to respond, including referral for cognitive behavioural therapy where needed and devising management plans jointly with patients.
  • GPs changed the way they consulted, putting more emphasis on self-management, and recognising the value of user involvement. There were also improvements around patient information processes, referral to physiotherapy, and fewer cancelled appointments.
  • Similarly, patients became more aware of the difficulties GPs face in treating back pain.
  • The learning from the team’s work has the potential to be applied in other clinical areas. The project has been presented at national and international conferences and the team has published several papers.

Further reading