We cut appointments and depression scripts with relationship counselling
Dr Michael Dixon explains how offering relationship services helps patients and reduces GP workload
What we did
My practice has a list of 16,800 patients and we found that much GP appointment time was taken up with patient stress, often related to family and couple relationships. Therefore we were interested when we were approached by a local charity, Mid Devon Community Family Trust (MDCFT), which offered to deliver relationship teaching to patients.
The Families Connecting service (FC) offers relationship education as one-to-one sessions. It can be used for both parenting and romantic relationships, either individually or for both parties. Initially we ran it as a weekly three-hour drop-in session, but within six months it became appointment based and we now have a weekly four-hour session as referrals increased. Patients are offered hour-long sessions with two volunteers: a lecturer in education who has been in relationship education through MDCFT for 16 years and a retired social worker.
The surgery funds the Disclosure and Barring Service checks for the educators and provides a room. Other expenses are met by MDCFT. It cost £1,000 to set up and running costs are now £28 per month. One GP meets the relationship educators twice a year to monitor the programme. The service is constantly full. It meets the needs of patients who are struggling with their relationships, giving them the opportunity to discuss a range of practical solutions. The average number of sessions needed is four, although some people attend only once and others more than 12 times.
It is a very full list so we are not able to offer sessions close together. We had concerns over the qualifications of the educators, but we now have developed a university-accredited training course.
A total of 107 patients have attended FC sessions so far, and we have data on 53 of these patients, which show that 45 of them have attended fewer GP appointments. In 15 out of 35 cases, GPs offered FC instead of antidepressants. In a survey, 54.5% of patients agreed their relationship had improved. The highest level of reported impact was on patients’ improved understanding of themselves or their relationship. Most indicated that they would recommend the service.
GPs indicated that FC enabled them to refer, instead of feeling frustrated that there was no service to meet their needs, and little time to discuss problems. GPs also said that fewer patients had been referred to NHS mental health services. Personally, I like the flexibility in terms of referring individuals or couples. FC overcomes the frustration of not being able to help, or of having a mental health services referral declined because the situation is not deemed serious enough.
This can save the practice money: if a 10-minute consultation with a GP costs on average £35, the 45 patients who saw an FC counsellor instead represent an approximate saving of £1,575.
The next challenge is to train more volunteers and to continue to develop clinical governance and qualifications.
Dr Michael Dixon is a GP in Devon and is former chair of NHS Alliance. This article was written with Vivien Southall of Mid-Devon Community Family Trust