Pain: Equality of Care and Support in the Community (PEACS) was established to provide an alternative solution to supporting people living with chronic pain, particularly those from Black backgrounds who experience a number of health inequalities, poorer outcomes and greater barriers to care compared to white people. Unlike more traditional approaches, the PEACS model was developed using Bio-Psycho-Social and Lifestyle Medicine Frameworks, to equip patients with the necessary skills and knowledge to allow them to better manage their experience of living with chronic pain.

We worked with a Black-led design agency to codesign the chronic pain pathway to better understand the issues and challenges within the healthcare system. This allowed us to map out a more suitable pathway, supporting the holistic needs of the patient group and including key factors around access, experience, and outcomes. In its first year PEACS supported a total of 597 people, 296 of those were people from black communities. Year two of the project commences in January 2024.

Read the year one report

The purpose of this report is to capture the evolution of the PEACS programme. The report outlines the background and context of this work, describes the codesign and implementation phases and finishes by describing some of the early findings from year one, key reflections and conclusions, before exploring recommendations for year two. The report includes special acknowledgements. It also contains forwards from Dr Mike Dilley, Dr Siobhan Gee and Prof Mark Edwards, Clinical and Academic Directors, Mind & Body Programme and a forward from Joseph Casey, Director of Partnerships and Programmes, King’s Health Partners.

The Tavistock Institute of Human Relations (TIHR) was commissioned to independently evaluate the PEACS project. An executive summary is available below.

If you would like any further information on the PEACS programme please contact misha.gardner@slam.nhs.uk, Project Manager, Mind & Body.

Read the Executive Summary of the Year one Evaluation Report to discover key insights, conclusions and recommendations for year two.

Introduction

The Year one evaluation report of the PEACS (Pain: Equality of Care and Support in the Community) service for people living with chronic pain tells the story of the first year of delivery. It outlines the evidence of outcomes for participants, staff and the wider healthcare service so far and discusses the enablers and barriers to achieving project outcomes. The report concludes with considerations and recommendations for Year two and onwards.

The PEACS service was co-designed with experts-by-experience in 2021, based on taking a bio-psycho-social approach to supporting people living with chronic pain, in particular focusing on engaging people from Black communities. The service is being delivered by King’s Health Partners (KHP) together with StockWellBeing PCN and concluded its first year of delivery in October 2023.

The developmental, process and outcomes evaluation has been using a mixed-methods approach, drawing on a range of qualitative and quantitative data, to answer the evaluation questions for year one.

Key insights

The project team, consisting of clinical and non-clinical staff, delivered the PEACS service in four cycles and several steps per cycle. These steps included a search and contacting phase, initial engagement activities (introduction workshop and one-to-one assessments), seven intervention workshops and progression to community activities.

Outputs

In total, the service supported 597 people, involving 244 individuals in initial engagement activities, with 139 people attending at least one of the intervention workshops. The service was successful in predominantly reaching Black people living with chronic pain, with proportionally more women aged between 45 and 64 years taking part.

Outcomes

PEACS participants in year one have reported a range of positive outcomes, chiefly:

  • Greater understanding of chronic pain;
  • Improved self-management of chronic pain;
  • Improved physical and psychological health;
  • Increased social connections;
  • Greater access to community activities.

For the health service there were:

  • Early indications that the programme is raising awareness of chronic pain;
  • Mixed evidence on the impact of PEACS in reducing healthcare utilisations.

No data available as yet indicating that PEACS has had an impact on staff wellbeing or job satisfaction within the PCN

Enablers and barriers to the success of PEACS

The evaluation identified several key factors that supported and hindered the delivery of PEACS and achieving outcomes.

Enablers

  • Team composition, structure, and approach: Diversity of skills and experience, commitment to the project, shared values and learning culture.
  • High-quality course materials.
  • The creation of a group of people with shared experience of chronic pain.

Barriers

  • Timing and location of workshop sessions.
  • Some participant expectations of pain treatment from PEACS, leading to disappointment.
  • Pressure and workload of staff team.
  • Lack of integration with PCN processes.

Conclusions and recommendations

There is evidence from different evaluation sources that the PEACS service is providing an alternative and valued approach to supporting people living with chronic pain, leading to short-term outcomes for participants such as improvements in knowledge, health and quality of life. It has shown to work for a range of participants, though there are variations in the experience and outcomes depending on the context and starting point of individuals.

There is the potential for the service to lead to longer-term outcomes for participants, staff and the immediate health care system. This will be explored further in Year 2.

The service and delivery team have adapted and improved the service, using ongoing learning, throughout the first year. Integrating and embedding the service into primary healthcare, as part of ‘business-as-usual’, will be key to its sustainability and replication. Recommendations for year two include:

  • Review the Theory of Change and define the key ingredients of the service.
  • Define the most appropriate population groups for engagement, incorporating learning from those who do not access the service.
  • Consider maximum group size for the intervention workshops.
  • Facilitate further social engagement and integration with existing services for follow-up support.
  • Review team roles, responsibilities, and task boundaries.
  • Streamline operational requirements, including data processing and project management.
  • Review MBHC tool and follow-up review processes.
  • Explore how best to increase GP awareness and knowledge for supporting their patients with chronic pain.