Persistent Physical Symptoms (PPS)
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Background
The impact of chronic pain and other conditions with persistent physical symptoms (PPS) where there is no medical solution, is significant and growing, both for patients and the NHS.
This Ways to Wellness prototype, which explored the improvement of patient outcomes through specialist social prescribing that supported NHS services, offered a holistic, one-to-one personalised service for people with various conditions.
PPS account for about 20% to 40% of cases for GPs, and 50% to 60% for hospital doctors. Clinical solutions may not always be the best option, and clinicians may feel pressure to prescribe, when support to manage the condition and/or tackle wider issues might be more effective.
Patients who were eligible for this pilot worked with a specialist link worker, who supported them to identify and overcome barriers to managing their symptoms through an agreed action plan, which included a range of activities, such as:
Getting involved in local groups and activities
Developing positive relationships
Accessing specialist services and support
Healthy eating and cooking
Getting more active
Getting support around benefits and welfare rights
Our aim was to improve patients’ quality of life, and reduce their use of mainstream health services, by empowering and supporting them to better manage their conditions.
2. Who we supported
This prototype service was for:
✅Adults registered with one of the participating GP practices (Cruddas Park Surgery; Holmside Medical Group; Throckley Primary Care; West Road Medical Centre)
✅ Patients experiencing chronic pain/PPS, such as muscolosketal (MSK) pain and fibromyalgia, ‘functional’ stroke, Irritable Bowel Syndrome (IBS); non-epileptic seizures, and diffuse symptoms, e.g. breathlessness and/or sensory changes
✅ Those experiencing mild to moderate symptoms for between three months and three years (unless excluding sinister pathologies took longer)
✅ Patients identified as ready to engage in a more holistic management approach, partnering with clinical staff and adding non-clinical support
✅ Patient for whom sinister pathologies had been excluded and they were now living with symptoms
GPs, nurses and hospital and community healthcare professionals could make referrals to the service.
This is what some of them had to say:
“Our patients have benefited substantially from being able to spend dedicated time discussing PPS and setting personal goals for managing them…I strongly believe this approach to managing PPS really works and makes a difference for patients…When patients can understand their PPS and explore ways of managing and living with them then they rely less on medication, which means fewer side effects and interactions with other medication. It also result in fewer urgent presentations (often to different GPs), which improves continuity as well as patient safety…”
“I thought the PPS programme was excellent. I felt that for these patients that have struggled with various services for years, it was invaluable. In GP we don't have time in our 15 minutes to explore PPS in detail…Some of my patients are the best they have been in years after this programme.”
“I was delighted to have access to this service for our patients and every patient whom I referred spoke highly of their interactions.”
“The PPS project has been a great success for West Road Medical Centre both in terms of patient outcomes and in terms of reduction in demand on GP services. This demonstrates clear benefit at both individual and wider system levels.”
“The PPS programme has done excellent work…Explaining new perspectives on PPS to patients takes expertise and, most of all, time, which is so hard for GPs to give to patients in the course of normal clinic appointments. I'm very grateful for everything the PPS service has done.”
3. Impact
This two-and-a-half-year pilot started in April 2024. This case study video shows a patient who was supported through Ways to Wellness’ foundational Long-term Conditions project, but she also explains the impact of her chronic pain, and how social prescribing from Ways to Wellness helped her:
4. Evaluation and evidence
This project started in April 2024 and its detailed final evaluation is currently being carried out. This is expected to include:
Direct outcomes for patients (e.g. patient-reported wellbeing/quality of life improvements).
Outcomes for the NHS, such as reduced unplanned visits to the GP and/or A&E.
5. Partners and funders
This project was funded and delivered in partnership with the North East and North Cumbria Deep End Network, with additional funding from Ways to Wellness.
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Cruddas Park Surgery, Westmorland Road, Cruddas Park, NE4 7JT
Holmside Medical Group. Armstrong Road, Benwell, NE4 8QB
Throckley Primary Care, Tillmouth Park Road, Throckley, NE15 9PA
West Road Medical Centre, West Road, Fenham, NE4 9QB
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