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
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
The British Society of Lifestyle Medicine hosts information, an app and facilitator accreditation through as well as many webinars about video group clinics
Experience Led Care runs face to face and virtual training across the UK.
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 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.
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!
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.
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.