Next Steps

The following recommendations have been agreed by the Expert Advisory Group to give effect to the design principles and progress this model of care towards implementation:

1. Chronic pain speciality services are developed, implemented, and commissioned by Te Whatu Ora Health New Zealand.

2. Te Whare Tapa Whā as a holistic model of care for whānau living with living with chronic pain chronic pain, with four specialist hubs linked to localities ensure equitable access across New Zealand.

3. Research, training, and service improvement for paediatric and Māori whānau living with chronic pain is prioritised to improve outcomes and reduce likelihood for adult chronic pain services.

4. Networked local resident pain expertise that support patients and links primary care and other specialist care.

5. Gradual, sustainable growth of specialist medical, nursing, and allied health care resource with pain expertise: a. Specialist nursing and allied health pain specialist workforce, 1.2 pain specialist FTE per 100,000, distributed across the four hubs (currently 0.8 pain specialist FTE per 100,000) to provide the medical leadership to ensure patient continuity of care and deliver the outcomes of the national model of care. b. This would require sustained workforce growth over a period of time, with specialist pain nursing and allied health teams to increase FTE to enable the above ratios, and specialist pain physicians growing from 40 pain specialist FTE (2021) to 60 pain specialist FTE over medium-long term. c. Not every patient requires team-based care, but for those who do access to spiritual care, rehabilitation, psychosocial and mental health services, medical management and peer-support networks.

6. Workforce development and capability-building consistent with a biopsychosocial model including whānau champions, Kaiāwhina and Pacific navigators to build culturally safe services.

7. Full utilisation of telehealth to support place-based care to patients, provide education, improve the triage of referrals and to provide better access to specialist opinion in rural and remote areas.

8. National Clinical Network established that encompasses all pain specialities (chronic, acute, post-operative, cancer, paediatric): as a clinical leadership group that contributes to national guidelines, quality, safety, education, supervision, and improvement of the services nationally.

9. Nationally consistent outcomes measures based on functional improvement, health related quality of life, timeliness, and access (i.e., the joint Australian and

New Zealand electronic Persistent Pain Outcomes Collaboration (ePOCC)).