Experience of implementing and delivering group consultations in UK general practice: a qualitative study

Abstract

Background: Group consultations are a relatively new concept in UK primary care and are a suggested solution to current workload pressures in general practice. However, little is known about the experience of implementing and delivering this approach from staff and organisational perspectives. Aim: To explore the experience of implementing and delivering group consultations in general practice. Design: Qualitative telephone interview study. Methods: Topic guides explored the perspectives and experiences of general practice staff on the implementation and delivery of group consultations. Data analysis adopted principles of the Framework Method underpinned by Normalisation Process Theory. Results: Interviews were conducted with 8 GPs, 8 Practice Nurses, 1 Nurse Associate, 1 Practice Pharmacist, 1 deputy Practice Manager, 1 Healthcare Assistant. Four themes were identified: sense making of group consultations; the work associated with initiating group consultations; the experiences of operationalising group consultations; and sustaining change. Group consultations made sense to participants as a mechanism to reduce burden on primary care, enhance multi-disciplinary working, and provide patient-centred care. Implementation required strong leadership from a ‘champion’, and a facilitator had a pivotal role in operationalising the approach. The associated workload was often underestimated. Barriers to embedding change included achieving whole practice buy-in, competing practice priorities, and system-level flexibility. Conclusion: General practice clinicians enjoyed group consultations, yet significant work is required to initiate and sustain the approach. An implementation plan considering leadership, roles and responsibilities and wider organisational support is required at the outset. Further research or evaluation is needed to measure process outcomes.

Shared medical appointments in English primary care for long-term conditions: a qualitative study of the views and experiences of patients, primary care staff and other stakeholders

“…Challenges to implementation of SMAs reported by providers and SMA trainers in this study echo the ndings of Swaithes et al (7), which reported key challenges to the initiation and operationalisation of group consultation in primary care related to the amount of time and resource required to set-up the SMAs in practice. We also found that practice-wide 'buyin' was needed to successfully adopt and support this model, and that staff understanding and attitudes underpinned success.…”

“…Whilst it has been reported that over 100 practices across England have attended SMA training (3), the extent to which practices have successfully used the model is unclear. A review of the wider literature identi ed several barriers to implementation including administrative and resource challenges, patient resistance and suitability and role adjustments and uncertainties (7). Factors identi ed as supporting successful implementation in primary care include having leadership, teamwork and communication, alongside staff skilled in group facilitation (7).…”

“…A review of the wider literature identi ed several barriers to implementation including administrative and resource challenges, patient resistance and suitability and role adjustments and uncertainties (7). Factors identi ed as supporting successful implementation in primary care include having leadership, teamwork and communication, alongside staff skilled in group facilitation (7). The experiences of adopting and delivering SMAs in English primary care requires further investigation to understand how best to optimise the adoption and implementation of SMAs in primary care.…”

Supported self‐care is integral to lifestyle medicine: Can virtual group consultations promote them both?

“…There is also growing recognition amongst practitioners that supporting individuals to self‐care also has benefits for healthcare staff. For example, clinicians involved in delivering group consultations report developing better relationships with patients and colleagues 23 and feel more satisfied with their work 24 . This may in turn reduce healthcare professional's risk of burnout whilst improving their experience and the quality of their interaction with patients.…”

Implementing video group consultations in general practice during COVID-19: a qualitative study

“…Before the pandemic, group consultations (or shared medical appointments) started to gain traction as a potential means for managing rising demand in general practice. 2 , 8 – 12 Combining clinical care with elements of group education and peer support, group consultations have been delivered in a variety of formats for patients with long-term conditions or shared health concerns. 8 , 13 …”