This is a guest blog from Professor Fraser Birrell, Honorary of Lifestyle Medicine & Innovation, Newcastle University, Editor-in-Chief of Lifestyle Medicine, and Director of Science & Research, British Society of Lifestyle Medicine. In the blog, Fraser discusses the power of virtual group consultations to support the delivery of personalised care and some upcoming initiatives around offering virtual group consultations across the NHS.
Why is everyone excited about virtual group consultations?
Group consultations are clinical consultations delivered to a group of patients with similar conditions or needs. Patients benefit from a person-centred model of care which gives time for them to discuss what matters to them while also benefiting from peer support, better access and continuity. Clinicians benefit from more time to address the problems that matter to patients, not needing to repeat the same advice and report genuinely joyful experiences. The approach can also reduce service pressures.
Group consultations are sometimes regarded as a new care model, but have been embedded in NHS practice since 2008, for several chronic conditions, including inflammatory arthritis, chronic pain and diabetes.
This care model has been around for much longer than you think. Dr Joseph Pratt first used this to address healthcare inequality in 1905 for patients with TB in Massachusetts. He scaled the first group consultation model for chronic diseases widely across America and developed group psychotherapy too.
For the modern NHS there is good long-term data showing group consultations meet Healthcare’s Quintuple Aim. This is a patient co-authored expansion of Don Berwick’s Triple Aim, adding the clinician satisfaction and education elements to provide the most comprehensive summary of what great care looks like:
- Good outcomes
- Patient satisfaction
- Clinician satisfaction
- Cost effective
- Effective education
The evidence base
This approach is supported by research data, as shown, for example, in this systematic review in the international Journal of Environmental Research and Public Health. There is also compelling UK data in:
– Rheumatology: where group consultations have been successfully embedded into monthly review clinics for patients with inflammatory arthritis with active disease as well as those requiring long term follow up. Long-term this led to 40% of follow-up workload going through the groups and better access for all. The outcomes are as good as any other interventions, including expensive biologic therapies. Mixed methods study of a new model of care for chronic disease: co-design and sustainable implementation of group consultations into clinical practice | Rheumatology Advances in Practice | Oxford Academic
– Dr David Unwin’s low carb groups for diabetes & weight loss: where the group model is a key tool in supporting behaviour change for patients with type 2 diabetes. These moved seamlessly online during the pandemic, showing this is a flexible care model. What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss | BMJ Nutrition, Prevention & Health
Further exploration of the benefits of group consultations can be found in narrative review of the key evidence across chronic diseases and a systems approach to scaling group consultations, as part of a themed issue of the Future Healthcare journal. This also explains why the overarching term group consultations should be used, rather than any of the many specific models (patients like it and easy to underestimate the evidence if you have a narrow focus e.g. shared medical appointments alone): Process and Systems: A systems approach to embedding group consultations in the NHS | RCP Journals
For those who are interested in research data collection, accrual to the NIHR CRN adopted National Evaluation of Group Consultation Models Study (CPMS ID 48539), please contact Professor Birrell directly: fraser.birrell@ncl.ac.uk
High-profile medical leaders also support group consultations. For example, Professor Sir Andrew Goddard, President of the Royal College of Physicians from 2018-2022. Also, Dr Ellen Fallows, Vice-President of the British Society of Lifestyle Medicine, who has written a nice primary care case study for NHS England.
Why virtual group consultations?
The COVID-19 pandemic had many effects on delivery of care, one of those being that social distancing meant it wasn’t safe to deliver care in groups and limited resources had to be directed to caring for those who were acutely unwell.
So lots of care was deferred and waiting lists built up.
But this also inspired the Global Lifestyle Medicine community to come together with a series of webinars, to pool knowledge on Virtual Group Consultation models.
All 14 webinars are available as a resource: Virtual Group Consultations – The British Society of Lifestyle Medicine (bslm.org.uk)
Why now?
To meet the challenges facing healthcare delivery today and to support the development of personalised care we are now exploring how to most effectively scale up virtual group consultations across the NHS. The soon to be published Menopause Virtual Group Consultation Toolkit shows how this can be embedded across whole pathways to deliver system benefits.
This is likely to be integral to the Future Outpatients Programme with substantial benefits for bottlenecks and service pressures if minimal resources are made available to implement: Outpatient case studies can be seen here. There is probably no other single change which can leverage more high-quality care from the same clinicians, while reducing stress and increasing capacity within weeks or months. So we expect this to be widely implemented.
Where do I get more information & access training?
Clinicians who are patient-centred and have access to a group consultation facilitator will be able to establish this model of care very quickly, as they are using existing skills in a new context. But change is easier if your clinical team is onboard and especially if other departments are making the same transition. So please do look at NHS England initiatives. Otherwise these resources are a good starting point:
Existing PCI eLearning resources:
The PCI has a range of free eLearning modules which can be used to build skills for delivering group consultations, both-in-person and virtually.
All of these modules have been developed by subject matter experts, provide CPD, available 24/7 online and can be completed at the learners own pace. These modules include:
- Core Skills – build core skills and knowledge in personalised care
- Shared Decision Making – learn how shared decision making (SDM) can be used to improve health and care outcomes
- Remote consultation – explore how to deliver personalised care virtually
Other approved resources:
- Person centred approaches – This eLearning introduces the behaviours, knowledge and skills needed for practising person-centred approaches – such as values, core communication and relationship building skills, and engaging, enabling and supporting people.
- Virtual Group Consultations – explainer of what virtual consultations are, how they work, their benefits and how your organisation can establish them
- Group Consultations – a dedicated organisation aimed at supporting health and care teams to deliver group consultations