Posted on January 20, 2026
We led the Medicines Safety Improvement Programme (MedSIP) in the West of England from 2022-2025, focused on addressing the widespread prescribing of opioids for long-term pain.
While opioids are effective for acute and end-of-life pain, there is little evidence supporting their efficacy for chronic pain. However, their prescribing more than doubled between 1998 and 2018, leading to what has been described as an “opioid epidemic” in the UK.
Through a whole-system, biopsychosocial approach, the programme trained 155 practitioners in self-management techniques and group facilitation, leading to the creation of six new pain cafes/groups across Bath and North East Somerset, Swindon and Wiltshire (BSW) and Bristol, North Somerset and South Gloucestershire (BNSSG) Integrated Care Boards.
It is estimated that in the West of England this initiative has saved 17 lives and halved the risk of opioid-related death for 487 people.
We commissioned training, fostered collaboration, and actively addressed health inequalities, which included understanding the experiences of Black and Brown women to ensure accessible and equitable pain management.
The challenge
While opioids are very good analgesics for acute pain and pain at the end of life, there is little evidence that they are helpful for long-term pain. Despite this, they are widely prescribed for long-term pain, with opioid prescribing more than doubling between 1998 and 2018.
Long-term opioid use is common, with data from January 2021 showing that over 1 million people in England were prescribed opioids for more than three months.
Opioids increase the risk of mortality. It is estimated that for every 62 patients who stop taking opioids, one death is prevented.
There is significant evidence to show that chronic pain disproportionately affects disadvantaged groups, further compounding health inequalities. According to Versus Arthritis, people who experience high-impact chronic pain are twice as likely to live in the most deprived areas (30%) compared to the least deprived areas (15%), and is also more common amongst some minority ethnic groups (Black, South Asian, mixed and ‘other’ ethnicity), and amongst women.
Guidance from NICE is clear that opioids are not indicated for chronic pain and guidance from the Royal College of Anaesthetists emphasises the harm that can be caused.
A survey of primary care clinicians in the West of England revealed low confidence in explaining pain mechanisms, tapering opioids, and non-medicinal self-management techniques, highlighting a critical need for education and alternative approaches.
Our approach
Through our delivery of the national NHS Medicines Safety Improvement Programme, we have encouraged a reduction in the prescribing of high-risk opioids for chronic pain using a whole-system approach.
We have supported our local systems to move away from the medical model of prescribing towards a biopsychosocial model, including supported self-management.
We commissioned and funded 155 training places for the ‘Live Well With Pain 10 Footsteps Programme’ to empower practitioners with self-management techniques and confidence in explaining pain mechanisms and non-pharmacological support.
A further 24 practitioners received group facilitation training, leading to the establishment of six new pain cafes and groups in the West of England.
We added value by fostering practitioner-led communities of practice for peer support and collaborating with Integrated Care Boards (ICBs) and community partners to embed equitable, person-centred care, ensuring services were accessible and addressing unconscious biases within healthcare.
“Our community pain group, which has been running for six years, demonstrated how a biopsychosocial approach can reduce high-dose opioid use. Health Innovation West of England’s support through training and fostering a community of practice has enabled us to share our learning and inspire other practices to adopt similar successful models, strengthening a system-wide commitment to reducing opioid harm.”
Rachel Dolman, Senior PCN Clinical Pharmacist, North Wilts Border PCN
Impacts to date
This programme has delivered significant patient safety improvements and addressed health inequalities.
Modelling indicates an estimated 17 lives have been saved through reductions in chronic opioid use, and 487 people have had their risk of opioid-related death halved by decreasing high-dose prescribing.
The 155 trained practitioners are now more confident in explaining pain mechanisms and non-pharmacological self-management. Self-management is further supported through a resource library (hosted by Health Innovation West of England) for both practitioners and people living with chronic pain. This resource library has been accessed over 1,000 times.
The six new pain cafes/groups have reduced patient isolation, enhanced engagement with well-being services, and fostered patient-led support networks.
Critically, the programme actively engaged with under-represented communities, such as Black and Brown women, identifying and working to address racial and gender biases in pain management and improving service accessibility through local infrastructure changes and addressing unconscious practitioner bias.
“When I was working, I was taking more than the eight (tablets) I was meant to be. It was very unhealthy. It was just getting by. The fear of being ill forever is so debilitating. My doctor’s surgery put me in touch with Rachel and the Chronic Pain Group. Rachel was so welcoming. Having that people that understand what it’s like to be in that much pain was such a massive help from the start. Getting off the tramadol made a massive difference. I could do the things that made me happy. I was able to do art again and even do the dishes and housework because I wasn’t in a trance all day. There is so much more that I am able to do.”
Alice, member of a Chronic Pain Group in North Wiltshire
Next steps
The national programme focusing on reducing harm from opioids in chronic non-cancer patients ran from April 2022 to March 2025 and has now ended.
Learning on approaches and what works well will be fed into the next national Medicines Safety Improvement Programme: Reducing psychotropics used for behaviour that challenges in people with learning disability.
facilitation and biopsychosocial approaches, are being utilised for other chronic health conditions, including COPD.
Future plans include continuing to develop practitioner-led communities of practice to ensure sustainability and spread of learning.
Efforts will focus on making services more accessible and addressing unconscious practitioner biases to further close gaps in referrals and service offerings, building on the success of advocating for improved local infrastructure.
There are also ongoing discussions for further funding bids to expand community pain clinics and associated staff training, particularly in areas of high deprivation like Weston-super-Mare.
“I will take back to my practice the importance of community and community engagement in treating pain and the wide range of interventions and activities that can be helpful in treating pain, beyond medication.”
Healthcare professional
Start and end dates
April 2022 to March 2025
Find out more
Janet Scott, Senior Programme Manager and Patient Safety Lead, Health Innovation West of England janet.scott26@nhs.net.
