London NHS trusts launch ‘back school’ as new care pathway

Two London trusts are launching a 90-minute education session for people with low back pain, as part of a new care pathway to meet the latest clinical guidelines.


Back school is a response to NICE guidelines on low back and sciatica

Hillingdon Hospitals NHS Trust will start the ‘back school’ at Hillingdon Hospital on 12 October, followed by its Mount Vernon site a week later. Central and North West London NHS Trust is due to follow at the end of the month.

Alex Porter, deputy therapy manager and senior physiotherapist at Mount Vernon Hospital, said the initiative was a response to National Institute for Health and Care Excellence guidelines on low back and sciatica.

Published in November 2016, the guidelines highlight the benefits of exercise and rule out interventions, such as acupuncture and ultrasound.

‘Our local commissioners have already told us that they will be decommissioning acupuncture for low back pain, and we want to be ahead of the trend,’ said Mr Porter.

Another aim is to reduce waiting times for physiotherapy. Mr Porter said many patients faced a long wait for an appointment, when all they required was advice.

A back school session starts with a presentation about anatomy, medications, when to seek help and myths about back pain, with time for questions and answers.

This is followed by an exercise session with physiotherapists, while another physio triages patients using information they have provided and the STarT Back screening tool. Patients may have a one-to-one with a physiotherapist, if the assessment process finds this is necessary.

Review planned

‘We are going to roll this out, then review it after about eight weeks,’ said Mr Porter. ‘We will look at patient satisfaction rates, outcomes, whether GPs are referring correctly, and get staff feedback on whether it’s working or if we are still booking everyone in for a one-to-one because patients are not satisfied with just an education session.’

Initially the back school will take referrals from the trusts’ consultants and extended scope practitioners. Meanwhile, the two trusts will be making sure local GPs are aware of the new pathway. If all goes well, GPs will start referring patients in November.

Initially a back school will offer five further exercise sessions, which Mr Porter described as a ‘gold standard’ because evidence shows this number of sessions produced good results. However, if the review suggests fewer sessions may be effective, the number could be reduced.

‘Certainly some of our patients will be coming to the back school and then five exercise sessions,’ said Mr Porter. ‘That will be six contacts, which is probably a lot more than other trusts are able to give.’

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