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Group consultations in general practice

New consultation types, including group consultations, are one of NHS England's 10 High Impact Actions to help practices free up time for GPs to provide more clinical care. But how do group consultations work? Rima Evans reports.

Holding a GP appointment with 10 to 15 patients at the same time rather than as a one-to-one may sound rather unorthodox.

But it’s a practice that is gathering pace. More and more GPs around the country are offering group consultations in a bid to squeeze more time out of the day so they can meet demand as well as improve health outcomes.

Practices in Slough were among the first who took up the initiative, using money from the Prime Minister’s Challenge Fund to start group consultations for diabetes patients.

Dr Priya Kumar, a partner at Slough’s Kumar Medical Centre, explains that the idea was introduced in response to patient feedback saying they wanted longer appointments with their GP; to be connected to other people with the same condition as themselves; to take control of their own health; and be able to set themselves goals for helping themselves.

Group consultations are a way of meeting those requirements, says Dr Kumar.

How do group consultations work?

Group consultations are usually medical appointments delivered to between 10 and 15 patients, all with similar health issues, in slots of around 90 minutes.

The sessions are run by a facilitator (either a clinical or non-clinical person) who first gauges what each patient would like to discuss or questions they want to ask, grouping them into themes to ensure the session is well structured. Patients will also have had any necessary tests done (for example, cholesterol) prior to the session and are invited to share them with the group.  

Following this, a clinician – this can be a GP or nurse - joins the group to begin the consultation, which typically lasts between 45 and 60 minutes. After the clinician leaves, the sessions is closed by the facilitator who will summarise the individual goals set as agreed with the GP or nurse.

If a patient needs to see the clinician alone they can step out of the group for a few minutes.

Dr Emily Symington’s practice, Parchmore Medical Centre, was part of a pilot offering GP-led group consultations in Croydon, south London last year. The practice was keen to introduce them as as a way to help release GP time to provide more care, she says.

Dr Symington says that how the clinician manages the consultation can vary.

‘Some talk to the whole group and invite comments and questions. Others prefer to sit with each patient individually and have a conversation with them but, of course, with everybody else still able to listen in and make contributions.

‘Essentially, these are still consultations and therefore an opportunity for patients to ask specific clinical questions,’ Dr Symington adds.

 ‘They are not education or peer support sessions although there are elements of both of those. This is a new concept though and we should be careful not to make hard and fast rules. It’s about experimenting and using them in a way that will most benefit your practice.’

To overcome confidentiality issues, patients signed consent forms.

The benefits of group consultations

The Croydon pilot involved six practices with 24 consultations held in total, for diabetes and COPD patients.  

Independent evaluation revealed some clear benefits (although Dr Symington warns that the final responses excluded patients that didn’t attend the last session so may be skewed). Nevertheless, patients scored the consultations highly with more than half of the diabetes patients saying they preferred the group consultations.

There was also progress seen in baseline scores around self-management with patients feeling more in control of their health and that health was their responsibility.

The initiative also achieved improvements in clinical outcomes for type 2 diabetic patients. The average reduction in HbA1c for diabetic patients was 7.1 mmol/mol; poorly controlled patients achieved twice this, at 13.2 mmol/mol. COPD patients saw no improvement though.

Additionally, although there were reservations at the start, staff were positively surprised by patients’ response and said they would recommend group consultations to colleagues.

Dr Symington says that, crucially, this kind of consultation changes the dynamic so the emphasis is much more about patients gaining greater understanding and taking control of their condition.

‘Our evaluation didn’t show it, but there was also anecdotal evidence that patients attending group consultations then didn’t present so frequently,’ she adds.

Peer support

Dr Kumar agrees the peer-to-peer support is invaluable for patients. ‘They appreciated being able to get advice from someone else going through the same thing, rather than the clinician who can give medical advice but may have no experience of the condition.

‘We were also surprised to find that patients are happy to share their results. They would then be able to directly ask each other how they achieved that result, so it was useful.’

It’s not just in the areas of diabetes or COPD the group consultation format can be used. In Slough, Dr Kumar also widened it out to children with asthma and their parents.

It’s a question of trying and testing what it can be applied to, says Dr Kumar, since it is all so new.

Do they help ease workload?

So, do group consultations increase efficiency and productivity and ease workload? In theory, yes, since GPs are seeing multiple patients in a shorter space of time. Meanwhile, patients feel they are getting 45 minutes of a GP’s time as opposed to 10 minutes.

But while group consultations still remain the exception rather than the norm, the administration time required to set them up means those gains will only be realised in the long run.

Patients have to be actively recruited which takes time and effort and, Dr Symington admits, the response from patients was mixed.

The approach is not for everyone and that goes for both patient and clinician, says Dr Kumar.

Undoubtedly clinicians have some new skills to learn, she adds. ‘Really those are about managing a group. So ensuring one person is not dominating the session, for example, and keeping discussion inclusive. Getting over the barrier of being able to share results in a group setting is also a new thing.’

Training of the facilitator is crucial, says Dr Symington. "They have to know how to hold the group together, keep people talking and liaise with the clinician. We felt a healthcare assistant or confident member of reception staff was ideal for that role."

Both the pilots in Slough and Croydon used a training programme provided by Experience Led Care (ELC).

It’s still too early to gauge the cost effectiveness of this model. In Croydon, additional costs were incurred mainly by staff time and training but the latter is not an ongoing cost.

Both GPs admit a challenge is maintaining momentum – setting up group consultations is time consuming and requires commitment. Some practices in Slough did struggle with it, says Dr Kumar.

‘But I would like to see it become more network-based,’ she says. ‘So practices that are willing to work in this way could include not just their patients but patients from across the CCG area. It doesn’t have to be organised by every practice for all patients to benefit from it.

‘It’s all work in progress and we are continuing to push it.’

Dr Symington is similarly optimistic. ‘We need to change healthcare delivery. If we don’t try anything new we will just keep getting the same outcomes.’

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