Group consultations are a way for primary care practices to bring together individuals for support with long-term conditions, helping them to better manage their own health and share their experiences and learning.
While a traditional clinician and patient appointment, such as an asthma or diabetes review, lasts around 10-15 minutes, group consultations can run for around 90 minutes and allow up to 12 participants to spend more time with their healthcare team – and each other. The sessions are generally led by a facilitator, who could be any member of the practice team, with medical or therapeutic input from the appropriate clinicians or allied health professionals.
Group consultations have been delivered face-to-face for some time, but during the coronavirus pandemic work focused on developing ways to offer them online. The most important consideration is that they continue to foster a sense of community between patients and staff, allowing everyone to learn from each other in a safe and secure setting, making a real difference to day-to-day life.
How the work was developed
The success of face-to-face group consultations for some people had already been proven in a number of studies by the time the pandemic hit in 2020. Since then, Dr Ellen Fallows, a GP at Brackley Medical Centre in Northamptonshire, has been working with the Digital First Primary Care team at NHS England and NHS Improvement to see how they can deliver the same benefits on an online platform.
Dr Fallows had already been involved in the development of in-person group consultations, and spent a year supporting ELCworks and the Digital First Primary Care team to create virtual training in providing a video version for over 700 primary care team members across England. She also set up her own video group consultations delivering an intensive lifestyle medicine programme for Type-2 Diabetes through a local medical practice to continue testing the concept.
Using a partnership approach
Dr Fallows is now working with colleagues from across Bicester Primary Care Network (PCN) with the support of Cherwell District Council and Citizen’s Advice North Oxon and South Northants to spread the use of video group consultations for long-term conditions.
The project is being funded through an award from the Peter Sowerby Foundation, which provides grants for piloting digital solutions for healthcare innovation.
One of the benefits of this joint approach is the ability to integrate social prescribers and district council initiatives such as the Move Together programme amongst others, which offers a more holistic approach to long-term conditions.
For example, the groups on Type-2 Diabetes covered topics such as sleep, physical activity, stress management, food, social isolation, and relationships as well as medications – helping people to manage their everyday life.
In addition, the group sessions are less paternalistic than traditional appointments – allowing the team to offer more personalised care and supporting patients to get the most out of their clinician. The service is about moving the agenda closer to that of the patient than that of their clinician.
Another beneficial aspect of the groups is that they bring together people with similar conditions in a safe space, with clear ground rules or “shared agreements” where they can disclose as much or as little personal information as they wish.
As the work has been developed across the PCN rather than within an individual practice, it is a good future model for spreading good practice, as services start to work more as integrated care systems.
“I think it comes down to good local relationships,” said Dr Fallows. “I knew the clinical director for the PCN and discussed the project with them, before rolling it out across interested practices. Since practices have had to develop new ways to respond to the pandemic, there aren’t many barriers to using video consultations – most practices have a webcam and headset and, while dual screens are useful, they’re not necessary.”
She continued: “In my experience, group sessions are very energising for teams, whereas telephone conversations can be very transactional and isolating. Group consultations allow clinicians to learn from colleagues by talking with patients in the same space rather than at separate appointments, which supports multidisciplinary working in a way that primary care hasn’t seen before.”
In the future the team expects to see a blended approach of face-to-face sessions followed by video group sessions. They have found that some people, for example the elderly or those with mobility or obesity issues, may feel more comfortable joining online in their own space rather than having to travel to a health centre; some people even expressed a preference to be present just as a head shot and prefer the anonymity this gives them, particularly when discussing sensitive topics such as body weight.
Although much more work is needed to evaluate this approach over the longer term, with different groups and at scale, group consultations may have the potential to deliver more personalised care in a way that could benefit both patients and their health care team; the aim being to bring the joy of working as team with patients into primary care.
National materials are available and can be tweaked for local use. An e-learning video and templates are available and a toolkit hosted on the FutureNHS Collaboration Platform under Video Group Clinics. There is also more information particularly on facilitator skills training on the British Society of Lifestyle Medicine website.