Objective : To share our experience developing an integrated spinal service, including a Spinal Assessment Clinic (SAC), Data Collection Centre, self-help Spinal Fitness Programme, three month Multi-disciplinary Spinal Rehabilitation Programme surgical service and Spinal Support Group. The Service was commended in the National Nye Bevan Awards and won the Millennium Nurse of the Year award surgical category.

Design: The SAC has operated for three and a half years and includes two nurse practitioners and an extended scope physiotherapist. Over 1000 patients per year are assessed, investigated, educated and commenced on a management plan by the practitioners, including data collection pre and post treatment. The three-month Rehabilitation programme is based in a sports complex and runs in collaboration with the private sector. The patients seen by MK are fully investigated and have failed conservative measures. The patient-led Spinal Support Group counsels all patients prior to treatment, feeding back related problems. The sole consultant (MK) has developed formal links with another spinal surgeon combining operating, clinical and audit sessions.

Outcome measures: Reduced out-patient waiting times, patient satisfaction survey, discharge rate following self-help Spinal Fitness Programme, number of complaints.

Results: Waiting time reduced from 89 to 16 weeks, urgent cases are seen within twenty-four hours. One hundred patients polled by questionnaire: 70% regarded their experience through SAC as excellent, 28% good and 2% fair. 70% were discharged six months following the self- help Spinal Fitness Programme. SAC had three complaints in three years, none for a missed diagnosis.

Conclusion: We would commend this service model for consideration by our colleagues.