National improvement initiative operationalising a 7 Phase Whole System Approach Framework (WSA7) to improve the management of chronic pain and decrease high-risk opioid prescribing across integrated care systems in England

BMJ Open Qual. 2026 Feb 5;15(1):e003758. doi: 10.1136/bmjoq-2025-003758.

ABSTRACT

BACKGROUND: Challenges in the management of chronic pain have resulted in concerning levels of high-risk opioid prescribing across England, highlighting the importance of personalised care and coordinated working across whole systems.

AIM: Improve management of chronic pain by reducing chronic and high-dose opioid prescribing and increasing awareness and availability of biopsychosocial support.

METHODOLOGY: Mobilising activity across the macro, meso and micro levels of the healthcare system in England, the initiative employed a novel 7 Phase Whole System Approach Framework (WSA7), enabling diverse stakeholders to coordinate improvement and learning activity to understand the local problems, coordinate change ideas and consider how to sustain improvement across the pathway of care.

FINDINGS: Predefined national outcomes relating to opioid prescribing were achieved: There was a 5.13% decrease in the rate of chronic opioid prescribing vs baseline, equating to 56 403 fewer people prescribed chronic opioids than would have had the rate remained at baseline levels, preventing between 841 and 910 deaths. Decrease of 20.35% in rate of high-dose prescribing versus baseline, halving the risk of opioid-related death for 16 963 people. Increased availability and awareness of biopsychosocial support; at least 12 093 patients supported to self-manage their pain. 27 integrated care systems (ICSs) fully participated in the initiative, five partially. Successful implementation of the WSA7 (n=19 ICSs) achieved greater sustained improvement vs non-participating ICSs (n=10), ICSs with implementation failure (n=8) and partial implementation (n=5).

CONCLUSIONS: Employing the WSA7 created contextual conditions across ICSs that supported and sustained improvement in a complex problem that challenges health and care systems across England.

PMID:41644202 | DOI:10.1136/bmjoq-2025-003758