National Medicines Safety Improvement Programme

Background

Opioids are very good analgesics for acute pain and pain at the end of life but there is little evidence that they are helpful for long-term pain. The National Institute for Health and Care Excellence released guidance stating that opioids are not indicated for chronic pain, and guidance from the Royal College of Anaesthetists has been clear about the harm that can be caused.Despite this, opioids are still widely prescribed for chronic pain.

The National Medicines Safety Improvement Programme aims to reduce prescribing of high dose opioids (> 120mg oral morphine) in non-cancer pain by 50% by March 2024 (without increasing risk of harm to patients from other causes), nationally preventing 500 hospital admissions and avoiding £1.75m in admission costs.

Our work

The scoping phase of this work completed in 2022 identified over 130 interventions nationally that were being used to reduce use of opioids for chronic pain. These interventions have been grouped into 5 themes – prevent initiation, de-escalate, find chronic use, treat and sustain. More information about these themes can be found here.  

UCLPartners has formed a core working group and an Opioids Network with representation from Primary Care Networks (PCNs), community pharmacy, secondary care and mental health trusts across North Central and North East London. The aim of the  Opioids Network is to provide a platform for healthcare professionals, patients and voluntary/charity sectors to engage, share learning and develop better ways to manage chronic non-cancer pain. Please find links to recordings and slides from past Opioid Network meetings below.

Alongside facilitating the Opioids Network, we are also piloting a small number of interventions with a view of scaling them up, if proven to be of benefit to the patients and clinicians. Following the results of a survey completed by 169 primary care clinicians and through conversations with the Network membership, we are currently testing this approach with a small number of GP practices and have developed an implementation guide with a suite of material to support the work.

If you would like to use this material to test the GES approach in your locality, please do get in touch with our contacts below as we might be able to provide some support and would like to learn from you.

We also had feedback from primary care that some patients were leaving secondary care with a new opioid prescription, but their discharge letters did not contain important information like an indication for the new opioid prescription, or a stop/review date. Not having these details makes it challenging for GPs to appropriately manage these patients, and to help them avoid taking opioids for extended periods.

In response, we created a discharge letter audit to support secondary care to review the completeness of their discharge letters and make improvements as needed. The audit and a session about using quality improvement (QI) methodology to improve discharge letters are linked below.

GES Resources

1. Feeling ALIVE: I cAn LIVE well with pain – implementation guide
2. Patient Information Leaflet
3. Invitation letter
4. Confidentiality agreement
5. Demographic survey
6. Pre and post survey
7. Feedback questionnaire
8. Facilitators guide
9. Group education sessions
10. GES Implementation guide webinar

Other resources

1. Discharge letter audit for secondary care
2. Discharge letter audit QI session: Recording | Slides
3. MedSIP Pan-London Shared Learning Event slides

Opioid Network meeting recordings and slides

1. October 2022: Recording |Slides
2. January 2023: Recording | Slides
3. May 2023: Recording | Slides
4. November 2023: Recording | Slides
5. March 2024: Recording | Slides

Further information

Jessica Catone, Implementation Manager: Jessica.Catone@uclpartners.com