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Group clinics could provide personalised patient care and address social isolation while reducing clinician burnout and workload. But they are not a quick fix. Dr Ellen Fallows shares her experience
Group clinics could alleviate some of the biggest challenges for primary care – workload, patient demand and even staff morale.
The format allows groups of up to 15 patients to consult with a clinician in a structured manner with the support of a trained facilitator. Clinics can be delivered either in person or through a video platform and have been used for 10 years in the UK and for more than 20 in the US and Australia.
Group clinics can achieve much of what is done in a one-to-one consultation, such as arranging prescriptions, tests and referrals. A group consultation is generally 90 minutes long, so there is more time for patient support, education and problem-solving. Evidence suggests they can improve health outcomes, particularly for long-term conditions, and can allow more time for discussions of lifestyle approaches to health.
So group consultations may be a good option for dealing with complex long-term conditions, which require a time-intensive and holistic approach that can be challenging in the current workforce crisis.
How it started in my area
As part of a Thames Valley Health Education England GP fellowship, I set up group clinics at my practice to help people with cardiovascular disease and type 2 diabetes. We saw 180 people in group clinics and results included reductions in weight, average blood sugar and blood pressure – even though we often deprescribed (on the patients’ requests). Our PCN clinical director supported scaling up, but Covid-19 meant we had to change our approach. We offered video group clinics to patients across the PCN, to support them to ‘live well’ with long- term conditions such as depression, anxiety, obesity, type 2 diabetes, hypertension, COPD, chronic pain and menopause. The offer was also open to the general public.
In a deprived area of Oxfordshire, we searched for patients on a waiting list for musculoskeletal outpatient services and offered them both in-person and video group clinics to support chronic pain.
How the group clinics worked
A health coach was trained to facilitate group clinics using the e-learning for health video group clinic package, motivational interviewing and one-to-one sessions with a GP with lifestyle medicine expertise (me).
I have experience setting up and delivering face-to-face group clinics and in nutrition, obesity management, menopause, chronic pain management and lifestyle medicine.
We offered groups on fatigue and chronic pain, COPD and asthma, cancer, type 2 diabetes, weight management, low mood, anxiety and menopause. There were 100 participants from nine GP practices, and the majority of clinics were delivered virtually on MS Teams.
When we conducted a survey, 95% of respondents (39 patients) said they would recommend a group clinic to others with similar health concerns. Also, 95% of respondents found it useful to hear about other people’s experiences, and 98% felt comfortable sharing their health concerns. And 90% thought they had more time to get their questions answered. Patients reported feeling validated when they talked about their symptoms. One said it was helpful ‘knowing that others have similar issues and questions’, and another talked of ‘light-bulb moments’ after hearing others’ stories.
The groups were also helpful in reducing feelings of isolation. One patient said it helped ‘feeling I’m not on my own’, and another described the group as ‘a much-needed lifeline’.
There is a temptation in the NHS to hope that new consulting methods might ‘fix’ the problems – especially demand. But no single solution will solve the issues – particularly not in the set-up phases. New systems have to bed in and work must be done to inform and engage both staff and patients.
Nevertheless, I see huge potential in this way of working. It is well suited to any long-term condition and other clinical areas too. It also facilitates the joining-up of services in a personalised way for patients and supports them with self-care. And it can address critical issues such as workforce morale by enabling teams to work more closely together.
Most importantly, it addresses social isolation, which is a greater risk factor for ill health than obesity and smoking combined – and can, in itsef, be a driver for service demand.
Dr Ellen Fallows is a GP in Brackley, Northamptonshire and vice-president of the British Society of Lifestyle Medicine