Better together? Group consultations in the NHS

The healthcare service faces a number of challenges, ranging from unsustainable workloads and workforce shortages to long waiting times and the increasing prevalence of long-term conditions. Each of these challenges affects the wellbeing and satisfaction of healthcare staff and impacts outcomes for patients.

In an effort to address these key issues, there has been strong interest in new service models, such as group consultations, where clinical care is provided to groups of patients at the same time, rather than on a one-to-one basis. Group consultations are seen as a way to address rising costs and ease demand pressure, while also potentially improving efficacy and self-care. They can incorporate elements of group education, peer support, clinical discussion on individual treatment, self-management and prescribing decisions, and have been delivered in person, on video, or in hybrid formats. Despite a growing evidence base, we still know little about how delivery has changed over time, especially following the Covid-19 pandemic.

In order to explore this, we developed an online scoping survey for healthcare staff to find out how group consultations are being used across the UK, which patient groups are involved, and in what formats (in-person, video, or hybrid). This follows our 2020 UK-wide survey of NHS staff, where almost half of 800 respondents indicated that video group consultations had been set up in their organisation, service or team.

The online survey remained open from 3 February to 12 May 2023 and was distributed using multiple channels such as Clinical Research Networks, the Future NHS collaboration platform, the Health Foundation’s Q community, Clinical Commissioning Groups, NHS contacts in England, Scotland, Wales and Northern Ireland, organisations providing training on group consultations, as well as social media, and our own clinical and academic professional networks.

We had responses from 115 individuals working in general practice (75%), secondary care (16%) and community care (8%), including responses from England (92%) Scotland (7%) and Wales (1%). Most responders worked in organisations that had used group consultations (56%) or planned to use them in the future (25%). Half (51%) of responders were doctors, 17% were nurses and the remainder comprised a range of professional roles including pharmacists, dietitians, administration/reception staff etc. We had more responses from organisations in affluent areas, however, this is typical of such surveys and should not be taken as evidence that group consultations are used less in deprived areas.

Through the survey we found that before the COVID-19 pandemic, in-person group consultations were most common, but there was a rapid shift to online delivery during the pandemic. The number of organisations reporting online delivery has remained relatively stable into 2023, but over this period there was a steady rise in the use of in-person groups back to just below pre-pandemic levels, combined with an increase in the reported use of hybrid group consultations.

There was a diverse range of conditions that respondents reported providing group consultations for, the most common of which was diabetes. Figure 1 below shows which conditions respondents from primary and secondary/community care reported using group consultations for.

Figure 1 - Conditions which were reported as the focus of groups consultations by responders working in primary and secondary/community care

Microsoft Teams was the most popular platform for running (or planning to run) remote group consultations, with a few respondents also using Zoom and Accurx.

Many respondents who had experience of delivering group consultations were, in general, positive about the influence on job satisfaction, staff skills, performance metrics, team working, time management, or demand management, as well as patient knowledge, satisfaction and outcomes (although to what extent this reflects a self-selecting sample is unknown). However, some organisations discontinued group consultations due to factors such as poor patient engagement, staff capacity and motivation, pressures on clinical time (especially where staff found group consultations did not replace 1:1 appointments), clinical champions moving to other posts, lack of financial support, lack of physical space (for in-person groups) and IT issues (for video and hybrid). Respondents found group consultations time-intensive and ‘difficult to set up’ with one response from secondary care suggesting they mainly used them as a measure to ‘enable waiting time catch up and then return to 1:1’.

We asked those who had experience of using group consultations about a range of specific possible factors that might enable the planning and delivery of group consultations and while all were identified as important by at least two-thirds of responders, having a dedicated individual or team leading on group consultations and sufficient staffing to deliver them were seen as key enablers by at least 80% of responders. Similarly, many patient factors were seen as impacting ability to engage when group consultations were held remotely, with learning difficulties, cognitive impairment, physical limitations, mental health challenges and significant work or caring responsibilities seen as having an impact by 90% or more of staff responders. One of the respondents suggested that ‘despite closed captions, people with profound hearing loss [are] also reporting difficulty with video especially groups’.

In conclusion group consultations are a relatively new model which seem to be gaining traction and used for a wide range of conditions in a wide range of settings. They are seen by many as having a positive impact on care, but do require buy in and dedicated resource to be effective, and even then may not suit all patients. Any implementation will have to be done in such a way that no one is excluded from care or from any benefits that may accrue from peer support in group-based sessions. It remains to be seen whether group consultations delivered in person and/or remotely will be the solution that many proponents hope for. Our NIHR-funded study due for completion in 2024 aims to strengthen the evidence base with a specific focus on inclusion and equity.