UKSSB Quarterly eBulletin
January 2016





“Improving Spinal Care”
Charles Greenough (National Clinical Director for Spinal Disorders)

The Improving Spinal Care programme, previously known as the spinal transformation project, commenced in January. This is an initiative of the specialised commissioning in NHS England and is supported by the Trauma Programme of Care Board.

The Improving Spinal Care project will be rolled out to the Specialised Commissioning Oversight Groups (SCOGs) in the ten areas of England. Within these groups smaller groups of CCGs and hospitals will be identified for further developmental road shows to engender local uptake and modification according to local circumstances.

In addition at the BritSpine Meeting in April, some time will be devoted to the project on the Wednesday (6 April), and on Friday (8 April) afternoon a meeting of all interested stakeholders will take place to which all are welcome.

The project comprises two main components; the National Back Pain Pathway and the Regional Spinal Network (RSNs).


The National Back Pain Pathway

The National Back Pain Pathway is the product of the Pathfinder project which reported in 2014. The pathway is based on current evidence and provides seamless care management from the General Practitioner to secondary care. The majority of the care is provided in primary care and in the community, with core therapies being provided by community therapy teams. For the first time in England the high intensity Combined Physical and Psychological Programme (CPPP) is being implemented, this was a major plank of the 2009 NICE guidance. Patients with radicular pain will have an expedited care pathway. The pathway is managed in the community by “Triage and Treat Practitioners” who will form a constant point of contact for the patient and ensure delivery of coherent and expeditious care.

The principal objective of the care pathway is to improve the management of acute and subacute back pain and reduce the onset of chronicity. Key features of the pathway will be the use of the Start Back triage tool in general practice to indicate appropriate management. Routine X-rays and MRI scans will be requested only by triage and treat practitioners in cases of suspected red flags or compressive radiculopathy. Whilst surgical referral for neurological compression will be expedited, surgical referral for axial back pain will take place only at a multi-disciplinary review following completion of the CPPP.

For further information, please contact Professor Charles Greenough at charles.greenough@stees.nhs.uk.


Regional Spinal Networks (RSNs)

The Regional Spinal Networks are based on the same concept as the major trauma networks. The network will be based on the spinal hub where 24/7 emergency spinal care is provided. The spinal hub will work with regional partner hospitals to provide a network of spinal care both for emergency and elective conditions.

The networks have three primary objectives. The first is to support partner hospitals, where there may be one or two surgeons with a spinal interest undertaking non specialised spinal surgery. Regional meeting will provide improved support and governance for these surgeons in order to promote their continuing spinal practice. The second primary objective is to provide a networked system of emergency spinal care with electronically based referrals and the development of locally based and locally devised protocols for emergency spinal care. The third objective is to provide a critical mass of spinal surgical expertise at Regional meetings which will be on locally determined basis. The purpose of the meetings will to be provide improved audit and governance of spinal surgical practice and support to spinal surgeons within the network.

For further information, please contact Mr Ashley Cole at ashcole9@gmail.com whose update follows:
The Regional Spinal Networks Project is progressing and a template of how a network might look has been approved by the Project Board and circulated to the Societies' Executive for comments and suggestions before wider circulation around the membership. The appointment by NHS England of two full time posts starting in January 2016 to implement Networks and Pathfinder will hopefully give these projects some momentum. Further details will follow and an update will be given at BritSpine in April.


Spinal Cord Injury Service Review

At the initiative of the Trauma Programme of Care Board, NHS England Specialised Commissioning is undertaking a service review of the spinal cord injury service. This review started in January. It is well known that the spinal cord injury centres are struggling to provide a timely and satisfactory service for the admission of acutely injured patients. There are in addition significant geographical variations in this service with the South East of England being less well served.

The spinal cord injury service review, which will be clinician and patient led, will examine the adequacy of access for patients and will look in detail at the long term results of rehabilitation, especially in restoration of the individual to a full and active lifestyle, including, for example, employment, training, social integration, sport etc. It is many years since Sir Ludwig Guttmann expressed his desire to turn every spinal cord injured individual into a tax payer. The service review will pay particular attention to support the development and rehabilitation in society after discharge from the spinal cord injury centre.

For further information/comment, please contact Professor Charles Greenough at charles.greenough@stees.nhs.uk.


Complex Spinal Surgery Clinical Reference Group

Ashley Cole (Complex Spinal Surgery Clinical Reference Group Chair)


The Complex Spinal Surgery Clinical Reference Group (CRG), chaired by Ashley Cole, has just signed off a proposed policy for the use of BMP in specialised spinal surgery and this will go to NHS England Clinical Panel in the next few weeks. It is anticipated that all Stakeholders including the Societies will have the opportunity for comment within the next two months.


Office Matters

Julia Bloomfield – As many of you will remember Julia was appointed as the first Executive Assistant in 2012 to UKSSB, also providing administrative support to BASS, BSS and SBPR. Since then she has provided excellent service and has been involved in many aspects of subsequent development including arrangements for BritSpine, BASS and BSS meetings. This has frequently involved considerable additional out-of-hours work particularly close to the dates of the meetings. She has also updated the membership databases of the societies amidst the many other tasks involved in the day-to-day running of the Board and BASS. Julia has recently notified her intention to retire after BritSpine. A vote of thanks and presentation will be made at BritSpine in the UKSSB AGM.

Succession - Advice from both recruitment agencies and the BOA suggested that for our purposes this post would be more appropriately advertised as a Policy Officer. After advertisement and interview we have been fortunate to appoint a very well qualified and highly recommended replacement Dr Lenka Körner Nahodilová (PhD) who has significant experience in administration, policy development, education and research most recently in the University of London.