UKSSB Quarterly eBulletin
January 2016




Alistair Stirling (UKSSB Chair)

National Spinal Update - Background to Current Developments

Rapid change in healthcare is continuing apace both within and without the NHS. Whilst this is not always welcome to all, there is a financial necessity to optimize utilization of the resources provided by taxation and maximize the return to the treasury for each health pound spent. Many debate whether recent change has improved this or had the opposite effect. Some calculations suggest that the indirect costs of spinal disorders to the UK economy may be as much as £17bn with a direct cost of £2bn.

In 2008 the inadequacy of secondary care provision for spinal disorders and the associated costs were recognized by the Department of Health (DH) and Sir Bruce Keogh asked the British Orthopaedic Association (BOA) to convene a taskforce to recommend possible solutions. Under John Carvell’s chairmanship this reported firstly in 2010 and in a more detailed report in 2013, see reference documents. Many of these recommendations have been or are in the process of being implemented. Later in 2013 many of the same group and others were asked to contribute to two workstreams:

In the first workstream, channeled through the Royal College of Surgeons and British Orthopaedic Association, the taskforce was asked to prepare commissioning guidance documents for the General Practice based Clinical Commissioning Groups (CCGs) focusing on non-specialized spinal care. In the initial version this included guidance for back pain and separately radicular pain. It was subsequently recognized that this was not a useful distinction in initial pathways. At approximately the same time DH redefined the principal domains of care and consequently spinal disorders were included within the Trauma National Programme of Care (PoG). For each of these domains a Pathfinder Project as an annual flagship initiative has been introduced. For the Trauma PoC, the first of these projects focused on back and radicular pain. This work started in September 2013 and was completed in May 2014, resulting in the Pathfinder document, now termed the National Backpain Pathway.

The second workstream focused on specialised services for which Clinical Reference Groups (CRGs) were introduced. The CRG’s membership is selected from the representation of all spinal societies as well as Regional representation. Part of the initial work of this (then the proto-group) was to define Service specifications for Specialised Spinal Surgery, see documents.

In parallel, but as a separate project, Tim Briggs as President of the BOA was asked to conduct a review of provision of Orthopaedic services nationally, see Getting It Right First Time GIRFT Report (2015). To deliver this every hospital providing orthopaedic services in England was visited and a report prepared analyzing:

  • Activity
  • Variation in practice
  • Minimum numbers of procedures
  • Implant choice and cost
  • Procurement
  • Complications
  • Litigation
  • Morale
  • Education Coding
  • AQP relationship

The bottom line was an estimated potential saving of £5 bn and on the basis of this work Professor Briggs has been appointed as NHS director of Clinical Quality and Efficiency.

The team has now been asked to conduct a similar review of all surgical services. This will include spinal services later this year with visits to many but probably not all provider sites. It is intended as far as possible to synchronise visits from the GIRFT and Improving Spinal Care project teams.


Current direction and intentions

As intimated by Charles Greenough in his article below there is now considerable momentum from DH to improve delivery of spinal care nationally with a dedicated project team appointed to assist with this and who started in post this month. Those directly involved in both the GIRFT project and Improving Spinal Care Project are listed in the Dramatis Personae (see in this eBulletin below but now also as a section on the website which will be updated as personnel change). Documents and developments from these initiatives will be posted on the UKSSB website under the heading Improving Spinal Care with the subheadings National Backpain Pathway (previously known as the Pathfinder project) and Regional Spinal Networks (RSN).


Dramatis personae

Many have asked whether there is a significant clinical input into the current NHSE structure and national initiatives. To answer this, a list of those involved in these is provided. As will be noted, there is a high level of both Orthopaedic and Neurosurgical representation.


UKSSB sponsored BOA Clinical Leaders Programme (CLP) – Applications now open

Following on from the success of the first Clinical Leaders Programme, the BOA has opened applications for the 2016/17 programme.  The CLP offers further educational support with a specific focus on developing leadership within Trauma and Orthopaedics and related disciplines.

Please see on our Fellowships page.