FAQs for Referrers
What kind of treatment do you offer?
What kind of patient should I be sending to your service?
How do I get funding for treatment?
So, what are the correct care pathways for adults and young people?
I am a GP. How to do I refer?
What happens after referral? What is the assessment appointment like?
Can I refer for medication advice, or for opioid reduction?
What investigations do you carry out?
I am not sure that my patient is ready for rehabilitation yet. Should I refer them?
What should I tell my patient about your service?
I am not sure whether the patient is at the right stage for your Young Adult programme. What should I do?
Where can my patient get more information?
What kind of treatment do you offer?
We offer rehabilitation treatment for people of all ages with complex, disabling non-malignant chronic pain. The intent is to help them to self-manage their lives better, and to do more, in the face of ongoing pain. We aim to help people to function better; we do not attempt to cure or reduce pain. For children and young people, their parents are an important part of rehabilitation, and a parent will also engage in treatment.
All of our rehabilitation programmes are residential – patients come and stay in Bath in a specialist centre at the Royal United Hospitals Bath. They are delivered by a highly specialist team who are exclusively employed at our tertiary, national specialist service.
What kind of patient should I be sending to your service?
We are a tertiary service. Patients should have attempted a range of treatments in secondary care (see “care pathway”, below). If these have a limited effect, and the patient still has high functional disability or a poor quality of life, then consider us. The patient needs to be aware that we take a non-medical, rehabilitation approach.
How do I get funding for treatment?
If you are in England, you don’t need to. Funding is covered by NHS England so long as the correct care pathway has been precisely followed – see below. In Scotland, Wales, Northern Ireland, The Channel Islands, Isle of Man or the Republic of Ireland, you will need to follow local procedures for ‘out of area’ treatment.
So, what are the correct care pathways for adults and young people?
For adults: patients need to have been seen by their local secondary care pain service, and need to have received appropriate treatment. If treatment is still ongoing in secondary care, or still planned, then referral to us should come afterwards. Ideally, the referral should take place from the secondary care service, or with their explicit approval. Of note, the pathway requires that the patient has seen a pain service; even if they have had good treatment in another specialty (e.g. rheumatology) this does not ‘count’ towards the care pathway.
For children: patients should have been seen by a paediatrician, in order that all appropriate investigations have been carried out.
I am a GP. How to do I refer?
Thanks for considering us; please refer where you are confident that the patient has followed the care pathway, above. There is guidance here.
What happens after referral? What is the assessment appointment like?
The referral is triaged, we collect background history and letters, and then the patient is booked for an initial online assessment appointment. This usually takes two hours and involves a Consultant and a specialist member of the rehab team, usually a Psychologist. The appointment involves taking a significant medical and psychosocial history, and looks at suitability for our treatment.
Can I refer for medication advice, or for opioid reduction?
We offer rehabilitation programmes that aim to help people function better, and to engage with their lives more. Thus, our Consultants will review medication, but this is not the main focus and should not be the main reason for referral.
Sometimes, when people have benefited from rehabilitation, they feel more ready to take on opioid reduction. However, we do not offer admission for opioid reduction.
What investigations do you carry out?
We presume that most appropriate investigations will have been carried out in secondary care. This is not the focus of our assessment. However, our Consultants will recommend investigations if they feel appropriate.
I am not sure that my patient is ready for rehabilitation yet. Should I refer them?
We are happy to talk to patients (and family) in assessment, and to review whether rehabilitation is the right choice – sometimes it isn’t the right time. Thus, if the patient is broadly interested, it is best to refer and we can discuss.
However, if the patient is (1) primarily interested in a medical / cure-oriented approach, or (2) struggling with a high level of personal difficulty unrelated to pain (e.g. substance misuse, severe psychosocial stress), then referral may be better at a different time.
It is also important to refer when a patient has completed other interventions that are likely to affect their functioning, e.g. significant surgeries for other medical issues, intensive psychological therapy.
What should I tell my patient about your service?
It helps if the patient, and family, understands that this is non-medical, non-cure-oriented rehabilitation service. We have good outcomes at helping people to improve their functioning and quality of life. However, this is achieved by a rehabilitation process, which can be tough. It engages body, mind and emotions. The emphasis will be supporting the patient to do more for themselves; although there is some care support available, being in rehabilitation means doing as much as possible for yourself.
Where parents are involved (with children or young adults) it helps for them to know that they will be fully engaged in treatment – that is, exercising, engaging in psychology work, for example. Parents remain responsible for children whilst they are on these premises.
I am not sure whether the patient is at the right stage for your Young Adult programme. What should I do?
We are happy to make the decision as to whether someone is best suited for an adolescent, young adult or adult programme. This will occur at assessment. Please go ahead and refer as you usually would and we will direct the young person after a thorough assessment.
Where can my patient get more information?
We can give plenty of information at the assessment appointment. You could also refer them to www.bathcentreforpainservices.nhs.uk , where there is much more information.