Introduction The Surrey and Sussex Healthcare Trust outpatient pain service is used for both the diagnosis and management of chronic pain. There is an increasing demand over the last six years with regard to new referrals. 881 new outpatients were seen in 2016. However, the total number of referrals in 2016 increased to over 1,600, leaving a backlog of more than 700 patients. The did-not-attend (DNA) rate in 2016 was 14.7%; this has been relatively consistent over the last six years, at an average of 12.5% (±3%). Furthermore, there is an increased demand on inpatient pain service (often acute-on-chronic pain). In 2016 there was 795 inpatient referrals, an increase of 18% from 2015.

The Problem This demand has become increasingly difficult to meet by the current workforce in the pain service.

Intervention 1. A new chronic pain consultant has now been appointed in 2017 to help meet this demand.

2. Teaching on the management of chronic pain and the appropriate time for referral to the chronic pain service is planned for junior doctors in training to reduce inappropriate referrals and improve the quality of referrals.

3. A chronic pain clinical nurse specialist is needed for the service; this is yet to be implemented.

Learning Points 1. The increasing demand on the chronic pain service is a long-term trend and the service requires intervention to continue functioning effectively.

2. This intervention needs to be implemented at multiple levels of the service including staffing, the referral process, and education of those healthcare professionals who will be referring to the service.

Conclusion With a better understanding of the management of chronic pain at a junior level patients will benefit from more effective treatment and the burden on the pain service will be lessened. This is the responsibility of those involved in the pain service to provide education to better this understanding.