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Are Group Consultations for me?

A short introduction to being seen by your doctor or nurse in a group rather than a short one to one consultation.

What are group consultations?

Group consultations (or group clinics) are a way of getting healthcare with others rather than on your own. There are a number of different ways of doing this, but the key is there is more time to discuss your problems, share the burden and solutions. People find this and enjoyable and empowering way to get treatment. In general practice the usual way of doing this is called a ‘shared medical appointment’.

How did I get involved in group consultations?

About ten years ago, an American called David Sobel came to Northumbria Healthcare and spoke about the benefits of seeing patients this way. He made it clear that this was high quality care, but could also be very efficient, so I was intrigued: I do a lot of teaching, so I was pretty sure I had the skills needed. Three of us tried this way of consulting, but only our clinics for inflammatory arthritis really worked (not surprising, as we had no training!). After a couple of pilot clinics, we presented the data at the national British Society for Rheumatology meeting and won an Innovation in Development prize for it, which was exciting and helped persuade our commissioners to commission the service for two community hospitals, where we have been running monthly group clinics since 2010.

What has been our experience?

Patients have been really positive (rating them 10/10 across a whole range of questions) and 40% of my follow up patients are seen this way now. People are quite nervous about trying group consultations, but once they have tried it, almost everyone will try it again. We average 17 patients per clinic and always finish within 2 hours. I honestly believe we deliver better, more accessible care- I can see new patients every month until they reach low disease activity or remission (and 40% of all the patients do). Patients who are struggling with a flare know they can ring my secretary and see me personally together with other team members in the group clinic quickly or the nurse in a normal clinic, so that helps too. Two of my colleagues have also started their own group clinic, focusing initially on just early disease and the results are even better- 56% in remission by six months. When I share this experience with our patient support groups, more than 90% want to try group consultations.

Has research shown benefits?

In short, yes. There are lots of studies, especially from the USA, which show group consultations deliver care that is at least as good and often better quality, as well as being more efficient. We have done a trial showing this works in UK primary care too and can be delivered by pharmacists and will submit the interview-based research on our clinics to be published very shortly. This shows patients are empowered by getting care this way and helps to spread our experience.

What are the benefits?

There are many benefits for both patients and clinicians, which can deliver effective and efficient care.

Are there any pitfalls?

Not everyone likes the idea of being seen in a group, but the vast majority of those who try it actually prefer it. By increasing capacity as well as quality, group consultations can offer sooner access and better care. Regular consultations will still be available, so you have a choice. Our vision is to offer all patients that choice at their local surgery within five years. Your Chief Medical Officer, Professor Dame Sally Davies and Dr Michael McDonnell, the Strategy Lead for NHS England, already share that vision.

How do I get involved?

You already are! Finding out about group consultations is the first step. We are keen to know how many people are keen to have access to care this way, so please leave any comments or feedback below, provide your contact details if you want to be involved in persuading GPs across the country being trained to do this and can share this with your friends & family.

We welcome your thoughts on this topic 

Dr Fraser Birrell
Consultant Rheumatologist and Academic Lead of the UK Shared Medical Appointments Group

Discussion

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  • Vinod Kumar
    18th August 2017

    Leave a comment...I think it is an interesting idea and for someone who works in primary care, although the problems may not be the same, it would be very interesting to see a group of people together and consult. There will be issues around confidentiality I suppose but it may work better in secondary care as there will be a group of people with maybe the same problem. In primary care, we already have joint consultations i.e. DESMOND clinics, Pulmonary rehabilitation clinics and even pain clinics. Antenatal classes are a form of group consultations as well. Where I see the benefit will be to see a group of people with the same problem at the first presentation. Like 17 newly diagnosed hypertensives. It would be a fantastic opportunity to discuss the condition and what to do and give them the opportunity to discuss and ask questions about the condition. People who don't speak much will gain a lot just by listening. I think it is a good idea for select groups

  • Violet  Rook
    18th August 2017

    This is about the psychology of the group and tends to connect to the algorithm uses in databases which can lead to a stereotypical view of topics. Groups in regard to "talking therapy" and counselling often help individuals, but this aspect in GP care and physical illness seems less productive. Social contact is good for the individual, but the danger of one size fits all is proving a problem in society.

    Fraser Birrell
    18th August 2017

    What the patients who try it say is 'seen in a group, but treated as individuals'. There is no uniformity and this approach is consistent with personalising care, which we recognise is important. This creates the time to do that. For example, when discussing exercise there are swimmers, walkers and dancers, but the health benefits are realised by doing 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week. People share their approaches and that can inspire others to do what works for them.

  • Robert Davidson
    17th August 2017

    If I had a medical problem, the LAST thing I'd want is sitting in a Group of fellow 86 year olds moaning about their problems!!

  • Robert Davidson
    17th August 2017

    No Fraser, from this Geriatric the answer is still "no thank you, not for me.

  • Robert Davidson
    14th August 2017

    No thank you - not for me.

    Fraser Birrell
    17th August 2017

    Totally up to you, but would you tried it if a family member recommended it or if you get get seen the same day in a group, but had to wait a week for a 'normal appointment'?

  • Ian Fairclough
    14th August 2017

    This isn't new - Health Centres hold group clinics and have done for years i.e. antenatal clinics.

    Specialist Nurses hold minor illness group clinics. Some are held in the local pharmacy.

    Practice GPs hold group clinics, sometimes alone, but mainly with a Specialist Nurse in attendance.

    If I thought I had an "exotic disease" I wouldn't be happy discussing this in front of other members of the public - lol.

    17 patients in about 2 hours works out less doctor time than an individual appointment :(

    Also groups give less "one to one" time - but there is the possibility of more general information being dispensed.

    I wonder how I, as a member of the public, decides that it would be more advantageous to attend a Group Clinic than have an individual appointment?

    Fraser Birrell
    17th August 2017

    I agree- several centres have tried this (we have 100 practices trained so far), but in the UK as patients we don't have consistent access to care delivered this way. In the Cleveland Clinic they run 500 group clinics a week and see massive benefits.

    There will always be the option of the 1:1 consultation, but if half the people choose the group, that will improve access for everyone!

    You should speak to my patients who have tried it- they see a lot more of me (longer and more often) and constantly say how other people ask the questions they didn't previously get time to ask and they get time to understand their problems better.

    The key is to have an open mind and be willing to try it (see the answer above). We are short of doctors, so this is a solution that can be put in place quickly just by brief training and a silliness to try something new.

    Ian Fairclough
    17th August 2017

    You say " but the key is there is more time to discuss your problems, share the burden and solutions."

    I'm struggling with that statement - I don't understand how there can be "more time to discuss your problems" when you quote the average of 17 people for 2 hours? Unless everyone has the same symptoms which would be a rare occurance.

    I can agree with sharing solutions to a problem - but who in there right mind wants to "share a burden"- how on earth does this help? Sitting in a room with up to 16 other people and listening to them talk about their complaints would depress anyone who has their own problems.

    I have seen TV documentaries of medical teams who visit isolated communities in poor countries and I can understand why they have Group Consultations in these circumstances.

    If I attend a "group consultation" and it is discovered that to investigate my problem it involves me removing some clothing - do I do it in the group, or do I leave the room and make another one-to-one appointment? Thus increasing the time spent in the practice.

    As Robert Davidson said - "No thank you - not for me."

    Fraser Birrell
    17th August 2017

    Everyone is unique, but people's problems are more similar than you imagine. In my clinic we usually discuss joint flares, sleep disturbance & fatigue, plus issues with medications and how different problems are linked. If facilitated well, this is positive and empowering for all.

    If your problem needs an examination, then this can be done privately in a side room- this is known as a Physical Shared Medical Appointment. Our patients have a joint examination in a side room, while another team member does education and also many need a steroid injection and sometimes blood tests, which the clinic nurse does in a treatment room, so by the end of the clinic everyone has had all the tests, treatments and education they need & want.

    How long does it take to get an appointment at your practice currently?

    Ian Fairclough
    17th August 2017

    If I physically VISIT my practice at 08.30am any weekday morning I will will nearly always get an appointment that day.If I PHONE my practice at 08.30am(and manage to get through) any weekday morning I will nearly always get an appointment that day.If I phone or visit after about 09.00am I won't automatically get an appointment and will have to keep trying, or try the next day - they don't do "forward bookings"

    I forgot to mention that at our practice if you join www.patient.co.uk you can book an appointment online. Not much good for the old & infirm who aren't computer literate, or have the use of a younger family member. But the system works very well.

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