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NEWS: Group consultations could ease workloads

by in GP Practice Management, News

Group consultations could be a way of easing the significant work burden for GPs and nurses in primary care teams, a new study has suggested.

Research led by Keele University explored group consultations, which are a relatively new concept in UK primary care, to see if they could future proof the sector and reduce workload pressures in general practice. The study, believed to be the first to explore the experiences of staff from general practices in England in implementing and delivering group consultations, is published in the latest edition of British Journal of General Practice. It involved 20 multidisciplinary professionals – eight GPs, eight practice nurses (PNs), one nurse associate, one pharmacist, one deputy practice manager and one healthcare assistant – from 18 practices across six regions in England.

Eleven participants reported having embedded group consultations in their practice. They are delivered for up to 15 patients at a time – face to face or online – with at least one clinician alongside a facilitator and last about 60–90 minutes. The sessions were used for conditions such as diabetes, cancer care, chronic pain, asthma, chronic obstructive pulmonary disease, rheumatoid arthritis, depression, menopause, pre-diabetes, hypertension and cardiovascular risk.
The other nine said they had tried to implement the group consultations but stopped either temporarily or permanently.

In the interviews, it was established that group consultations made sense to participants as a mechanism to reduce burden on primary care, enhance multidisciplinary working, and provide patient-centred care. However, implementation required strong leadership from a “champion”, typically a GP or PN with an interest in either the approach itself or a particular condition that could be managed by group consultations.

A facilitator also had a pivotal role in ensuring the approach worked, but it was reported the associated workload was often underestimated, while some participants disclosed they came up against some barriers, such as system-level flexibility and getting everyone in the practice to agree to the approach.

Despite positive perceptions about group consultations, several participants reported staff resistance or hesitancy, often due to uncertainty regarding the approach itself or their role in implementing or delivering group consultations; individual beliefs about their capability or capacity to undertake group consultations and whether this was their responsibility; or the desire to adopt new roles and responsibilities.

Participants reported engagement ranging from “passive support”, where individuals did not hinder the set-up of group consultations but did not actively engage with the processes, to “blockers”, which saw individuals slowing or stopping momentum if they did not wish to engage in implementation or delivery.

The authors conclude that general practice clinicians enjoyed group consultations, but significant work is needed to sustain the approach. Further research or evaluation is needed to measure process outcomes.

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