Opioid Harm Reduction Programme

A personalised care approach to chronic non cancer pain management 

Approximately 14.2% of the population suffers from chronic widespread pain. Despite limited evidence, opioids are commonly used for its management, leading to dependency and increased mortality. In North West London, approximately 1,003 people are currently prescribed high-dose long term opioids. 


What are we doing in North West London?

North West London aims to contribute to the national ambition to reduce harm from opioid medicines by 50% before March 2024, and locally, aims to: 

  • reduce high-dose opioid prescriptions for long-term use and reduce prescribing of opioids in combination with other medicines known to cause harm 
  • develop a scalable, personalised model of care for chronic pain in primary care, focusing on keeping individuals out of hospitals 

ICHP, Dr. Ian Bernstein, and the NWL Integrated Care Board (ICB), are piloting Pharmacist-led opioid review clinics in Hammersmith and Fulham primary care. The model, supported by GP and PCN Pharmacists, conducts structured medicine reviews for patients on high-dose opioids or those using opioids alongside gabapentinoids. This approach emphasizes holistic and personalised pain management. Community MSk Pain Service provides support through advice services and monthly multi-disciplinary team meetings.

How can you and your team support better chronic pain management? 

Step 1: Education and training

Chronic Pain Management Webinars

Hosted by the NW London ICB

Long-read: Optimising personalised care

NHS England

NICE guidance: Chronic Pain


NICE guidance: Safe prescribing and withdrawal

Opioids Aware

Faculty of Pain Medicine

Medicines Safety Improvement

Future NHS

Step 2: Identify your Patient Cohort

You can access the Opioid Prescribing Comparators dashboard | NHSBSA which enables you to obtain the NHS numbers for patients flagged by prescribing comparators through a request to NHSBSA. Refer to dashboard tab: ‘supporting information’ > ‘patient details’ for how to make the request. 

Registration for ePACT can be sought by emailing registration@nhsbsa.nhs.uk. Further ePACT training support is available here. 

To read more about how NHS England plans to support Integrated Care Systems to optimise personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms, please see this framework published in 2023 

Improving chronic non-cancer pain management

NW London ICB

Step 3: Invite Patients for Review

Phone and SMS Script

NW London ICB

Step 4: Complete Patient Reviews

Self Management Navigator Tool

Pain Concern

Utilise support from Community MSk Services

If available in your area

Step 5: Offer a Personalised Care Approach To Pain Management

Optimising personalised care framework

NHS England

Step 6: Offer Patient Self-Management and Education Resources 

Live Well With Pain

Flippin' Pain

Tame the Beast

Retrain Pain

Decision Support Tools

NHS England

Step 7: Record Patient Review Outcomes 

Data Collection Spreadsheet

Suggested Patient Survey Questions

What is happening nationally? 

In England, 15.5 million individuals, constituting 34% of the population, experience chronic pain (Public Health England, 2020). Over 0.5 million people are prescribed opioid analgesia for more than three months, primarily for non-cancer-related chronic pain (AHSN Network, 2021). Beyond an oral morphine equivalent (OME) of 120mg daily, the risk of harm increases significantly. Tapering or stopping high-dose opioids requires careful planning, especially if patients continue to experience severe pain despite treatment (Gomes et al, 2011; Häuser et al, 2020). 

The Medicines Safety Improvement Programme (MedSIP) addresses the most important causes of severe harm associated with medicines, most of which have been known about for years but continue to challenge the health and care systems in England. The key ambitions for MedSIP are to reduce harm from opioid medicines by reducing high dose prescribing (>120mg oral Morphine equivalent), for non-cancer pain by 50%, by March 2024.  

Are you interested in using a Quality Improvement (QI) approach?

Follow our worked example in Primary Care

Want to know more about our Opioid Harm Reduction programme? Get in touch >