Regional Spinal Networks


Improving Spinal Care Project

National Low Back Pain Pathway and Regional Spinal Networks


Charles Greenough, National Clinical Director for Spinal Disorders

The report in 2013 of the Spinal Task Force demonstrated that spinal surgery in England is under pressure. In some areas there are no spinal services available, with patients having to travel to the next nearest spinal surgeon. Smaller hospitals face pressures in the provision of adequate audit and governance arrangements. Many spinal centres struggle to achieve compliance with the 18 week target. Some District General Hospitals have ceased to provide spinal surgical services.

The volume of spinal surgery is spiralling – the NHS in England spends £200m per annum on spinal surgery and there are currently approximately 10,000 adult patients each year that have elective spinal surgery. However there is a large variation in practice with inconsistent indications. In an addition, there are large numbers of patients being given injections with low evidence of effectiveness. Reducing ineffective but costly injections alone would save the NHS £9m a year.

Reviewing current practice

From a review of the service it was clear that that there were two main issues impacting on spinal surgery.

• Great pressure on smaller DGHs where perhaps one or two surgeons are providing an excellent service for non-specialised spinal surgery. A lack of peer support, a lack of broader audit and governance arrangements and considerable pressure from the 18 week target have resulted in many Trusts withdrawing from spinal services. This leads to the larger adjacent centres being overwhelmed, which inevitably means patients are waiting longer, and reduces capacity for emergency care.

• Large variation in surgical indications and rates between centres, which is unexplained. This in turn drives large variation in activity and cost between CCGs.
In addition, we found problems with waiting list management and fragile clinical teams relying on one or two individuals working in isolation.

How can we overcome these problems?

1. Setting up regional spinal networks.

The Regional Spinal Networks comprise a spinal hub and a number of partner hospitals. The spinal hub is a major spinal centre which undertakes specialised surgery with 24/7 availability of spinal surgeons, investigations and support. Spinal hubs will have integrated relationships with a number of partner hospitals which will in general be Trauma Units and District General Hospitals. The basis of the network will be a regular regional meeting, locally designed to meet local needs, where all surgeons will participate in a broader audit, governance and support structure. This will allow gradual convergence on best practice and much improved support for smaller providers. Written protocols for emergency care and referrals will be locally developed, ensuring safe and effective communication and allowing patients to be managed closer to home.

Next steps

Our Regional specialised commissioning teams will be working with the transformation team in each CCG commissioning collaborative to take this work forward. We are communicating with the Sustainability and Transformation Plan teams. We will also be inviting provider networks to take part in the peer review and design process on the future pathway of care.

If you are interested in being an early adopter of the Improving Spinal Care project email:




Document Downloads:


Spinal Networks Template


Terms of Reference Templates

A - Spinal Network Terms of Reference Template with subnetworks


B - Spinal Network Terms of Reference Template no subnetworks


Work Plan and Objectives Template

Template Regional Spinal Network Objectives & Work Plan


Spinal Networks CQUIN

Spinal Networks CQUIN 17-18


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