With rising workloads, restricted funding and patients with ever more complex conditions, change is needed in general practice. One solution is to adopt the American and Australian model of shared medical appointments (SMAs) – seeing patients with long-term conditions in a group, instead of giving individual 10 minute appointments.
After a slow start, SMAs have taken off in the US as a better way of managing the 70% of GP consultations that are now due to long term conditions that require more complex care than the infectious diseases of the past.
They work by a doctor seeing patients in groups of 8-12 for 60 or 90 minutes, where they discuss their problems sequentially (like an individual consultation), but within a supportive group that allows patients to listen, interact and learn from each other. The patients can all have one condition (for example diabetes, heart problems or pain management) or a mix of conditions (for example, a group of patients with long-term conditions).
SMAs offer great advantages to patients: more time with the doctor, peer support from fellow patients and input from other allied health professionals. SMAs also require a facilitator who organises the group, keeps medical records, guides the doctor through individual consultations, and may contribute to the consultation. Patients claim they learn more, don’t have to remember all the questions they usually forget to ask (because others ask them) and actually enjoy the process better than their usual care.
It is likely that SMAs will become just another part of the UK’s medical furniture.
Importantly, doctors also claim to enjoy the SMA as a welcome break from the routine 1:1 consulting, as they only have to have one discussion on diet, exercise, stress management and the lifestyle changes that underpin most chronic diseases, and not repeat it ad nauseam. Seeing the patients also saves the GP precious time, as they don’t have to repeat themselves, they have a documenter to take notes, a nurse to check metrics before they arrive and no DNAs.
There is plenty of research to support their success. A study funded by the Royal Australian College of GPs in Australia found that after 24 groups with more than 200 patient visits, all the signs were positive. As with published US data, there is almost 100% acceptance of the process with patients and doctors involved in the trials. And while these are admittedly self-selected, earlier work suggests that this level of satisfaction jumps from around an initial 75% to 100% once the process is tried.
GPs may, understandably, be skeptical about the concept. We have been brought up with a 1:1 consulting model yet there are more than 500 white papers telling us that SMA outcomes are as good or better.
Another potential barrier is inertia – GPs are overwhelmed as it is. But with a 40% reduction in patient return rates and a halving of time spent on surgeries, SMAs have to be viewed as serious adjuncts to usual consulting.
Meanwhile, patient and doctor satisfaction is very high – smiles on faces makes the daily workload happier for everyone in the whole practice. And patients sign a confidentiality waiver which has worked very well without a single resulting complaint.
Some up-skilling will be required for nurses and others to act as facilitators (or documenters who enable GPs to escape from their computers) but this should be minimal given a basic level of core competencies and specific health knowledge.
It is likely that SMAs will become just another part of the UK’s medical furniture.
Dr Rob Lawson is a retired NHS GP in East Lothian, currently working as a Lifestyle Medicine specialist, private GP and a health charity director.
Conflict of interest note: Dr Rob Lawson intends to run a training course for SMA facilitators.
