Top Tips on Setting up Group Clinics

I have seen over 300 patients in group clinics across two primary care networks and in 5+ different practices both in person and virtually involving training 3 different facilitators to support the process. Group clinics are a wonderful salve to our increasingly transactional micro-consultations; I think they bring back continuity, values-based and person-centred care and allow patients more time to talk about what matters most to them. Good luck and I hope you enjoy them as much as I do.

– Dr Ellen Fallows (GP) 2022

View the upcoming Virtual Group Consultations Webinar

Training/Resources

1.

E-Learning for healthcare hosts a free course on how to set up Video Group Clinics (many resources are the same for face to face group clinics) 2 x 20 minutes modules with tools and templates suitable for facilitators and clinicians

View the Course Here

2.

The British Society of Lifestyle Medicine hosts information, an app and facilitator accreditation through as well as many webinars about video group clinics

BSLM Group Consultations Information

3.

Check out our skills partners websites

Group Consultations Ltd. Website

Experience Led Care’s Website

Top Tips from Experience

Find a Good Facilitator

Facilitators need good communication skills and can be from any background (less health knowledge the better sometimes) need to be a “people person” and good at supporting administration for the groups. Main skills around professionalism, confidentiality, consent, health coaching, goal setting and IT. Could be receptionist, health coach, social prescribing link worker, HCA with the right support and training. In primary care England use Additional Roles Funding.

Start with Video Groups

On-line first can help if you have problems with space/Covid – MS Teams is OK just beware never Cc but Bcc attendees invitations for confidentiality purposes and check ID and consent as people log-in (see VGC training for all the other confidentiality and cybersecurity issues). Cameras on, check people are in a confidential space.

Your First Group Just Needs “Bums on Seats”

First groups just need people to turn up to support facilitator training and learn the skills of consulting in a group. They should not need to demonstrate clinical/demand impact yet. Key principle is that patients should talk as much or more than the facilitator/clinician. It isn’t an education session – focus is a coaching approach i.e. reflect questions back “has anyone else experienced this….”, “what have other people tried….”, “that must be very frustrating, anyone else felt the same?”. Start with patients you know, people who are already keen, patients with simple issues. Consider conditions such as the menopause/asthma – more discrete issues with high demand versus chronic pain, depression, type-2 diabetes or obesity which you can build to.

Consider Patient Recruitment Strategies From the Start

Group clinics require significant patient investment; feeling exposed, trying something new, spending 2 hours of their time. Consider how you are going to frame “what’s in it for me?” to patients. Consider what drives people to consult you – e.g. weight loss, low mood, fatigue, pain, too many medications, side effects. Remember, people don’t actually feel unwell with many long-term conditions such as CVD/hypertension/Type-2 Diabetes so unless unusually motivated they need to know why 2 hours of a group clinic will benefit them – focus on things that motivate people; the potential to come off/reduce insulin, losing weight, sleeping better, increased energy, improving mood; all of these improve with a lifestyle medicine approach. (you can still do your QOF review but don’t call it that but your “living well with Type-2 diabetes” or “want to lose weight and have more energy with fewer pills group”?)

Simplify the Process

Don’t fret about using results boards; if it isn’t working for you and you’re worried about consent etc then just get your facilitator to generate a “discussion board” listing the key themes/issues people want to discuss; the whole point of the session is an adult learning approach – patients tell you what they want to learn/discuss rather than you going in with a presentation saying this is what you need to know about X. Your trying to move away from paternalistic “you’ve got X, take Y” to a more collaborative approach.
Get feedback from the start

Get a Simple Feedback Form to use From the Start.

Use Google Forms for anonymous on-line feedback but remember these can’t be used for medically sensitive information as google has the potential to profile people and sell this data. Use a quality improvement approach; always meet with your facilitator after the group and review feedback and talk about what went well and what could have been done better. Check with your colleagues clinicians, reception and admin that the groups aren’t causing unintended consequences – consider unrealistically raising expectations about care, confusion that 1:1 appnts no longer available etc.

Manage Expectations

Manage your own and your partners/manager’s expectations; your first few clinics are likely to be poorly attended. Work on recruitment and your team’s skills and the scheduling. Get quotes from patients to share (with permission) on your website, put up banners, speak to local radio, send texts. When you start something new like this it will take at least 6 months to get up and running and to see clinical impact minimum another 6 months; don’t over-promise!

Diarise Regular Groups From the Start

It will be hard to get groups off the ground if you go in half-hearted with one group a month – schedule them every week and preferably over lunch or after work – people need to be able to commit to 2 hours. Warn managers this will take time to grow and it is normal to have small groups initially; nothing is going to fix demand issues within a year even. Remember, DNA’s or frequent attenders don’t matter. DNAs = more time with those who do turn up. Frequent attenders = expert patients who can share their knowledge. If no-one attends use the time to work on your recruitment approach.

Scaling Up

Once you’re confident with regular groups (expect this to take a year) then reach out to the hard-to-get/more complex patients – one to one phone calls by a social prescriber, do targeted searches and texts, present to your colleagues; particularly nurses and HCAs who see more patients than GPs!

Keep Going

Don’t give up if your first few groups have poor attendance; this is normal. Talk to reception about what you are doing, talk to your Patient Participation Group, get on local radio, put banners up, social media etc. It will grow but may take some time – get your managers on board with the concept of a quality improvement approach. Expect mistakes to be made and bad feedback occasionally – this doesn’t mean you need to give up but refine the process and improve. Focus on what the patients want.

Celebrate Success

Once you’ve got your groups going, collate results and share what you’ve learned with your local team, primary care network, at an RCGP or BSLM conference or webinar. Write up what you’ve learned for BSLM newsletter/blog. Use social media to share stories (with explicit written patient consent). Write up an article for BJGPLife or a research article with BMJ/BJGP etc. Allow other clinicians and training facilitators to sit in your groups; this is a skill that can’t be learned from reading/training alone.

Remember, change is tiring.

Finding your first followers (patients and healthcare staff) is the key to success – look after them because they will look after you.

Research Papers on Group Clinics:

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Naik AD, Palmer N, Petersen NJ et al. Comparative effectiveness of goal setting in diabetes mellitus group clinics: randomized clinical trial. Arch Intern Med 2011;171:453-459.

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Lavoie JG, Wong ST, Chongo M et al. Group medical visits can deliver on patient-centred care objectives: results from a qualitative study. BMC Health Serv Res 2013;13:155.

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Ganetsky VS, Long JA, Mitra N et al. Impact of a multidisciplinary, endocrinologist-led shared medical appointment model on diabetes-related outcomes in an underserved population. Diabetes Spectr 2020;33:74-81

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Reed SC, Partridge AH, Nekhlyudov L et al. Shared medical appointments in cancer survivorship care: a review of the literature. J Oncol Pract 2015;11:6-11.

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Palaniappan LP, Muzaffar AL, Wang EJ et al. Shared medical appointments: promoting weight loss in a clinical setting. J Am Board Fam Med 2011;24:326-328.

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Ayoub WT, Newman ED, Blosky MA et al. Improving detection and treatment of osteoporosis: redesigning care using the electronic medical record and shared medical appointments. Osteoporos Int 2009;20:37-42.

Yehle KS, Sands LP, Rhynders PA et al. The effect of shared medical visits on knowledge and self-care in patients with heart failure: a pilot study. Heart Lung 2009;38:25-33.

Roll MD, Spottswood M, Huang H. Using shared medical appointments to increase access to buprenorphine treatment. Journal of the American Board of Family Medicine 2015;28:676-677.

Jhagroo RA, Nakada SY, Penniston KL. Shared medical appointments for patients with kidney stones new to medical management decrease appointment wait time and increase patient knowledge. J Urol 2014;90:1778-1784.

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Cohen S, Hartley S, Mavi J et al. Veteran experiences related to participation in shared medical appointments. Mil Med 2012;177:1287-1292.

Edelman D, McDuffie JR, Oddone E et al. Shared Medical Appointments for Chronic Medical Conditions: A Systematic Review. Washington: Department of Veterans Affairs, 2012.

Cohen LB, Taveira TH, Khatana SA et al. Pharmacist-led shared medical appointments for multiple cardiovascular risk reduction in patients with type 2 diabetes. Diabetes Educ 2011;37:801-812

Wu WC, Taveira TH, Jeffery S et al. Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: a multi-center randomized controlled trial. PLoS One 2018;13:e0195898.

Chandra RN. Effectiveness of a pharmacist managed hypertension shared medical appointment. Conference Paper: American College of Clinical Pharmacy Annual Meeting, 2011.

Davis S, Johnson V, McClory M et al. Diabetes empowerment with a nurse-led shared medical appointment program. Nursing 2019;49:67-69.

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Clancy DE, Dismuke CE, Magruder KM et al. Do diabetes group visits lead to lower medical care charges? Am J Manag Care 2008;14:39-44.

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