Chrysanthi Papoutsi and Sara Shaw share an overview of their research on video group consultations during the COVID-19 pandemic in the UK.
‘Is anyone actually doing group consultations?’ one of our GP colleagues asked when they heard about our research.
The short answer is yes. But getting to grips with a model of care that involves groups of patients coming together for their clinical consultations is hard. It’s often seen as too much of a shift from usual practice, and as a crude cost-cutting measure with roots in the modus operandi of the American health service. In our research, we set out to understand if there is more to video group consultations than meets the eye.
In-person group consultations gained some traction in the UK before the pandemic, largely as a way of managing increasing workloads and fulfilling quality and performance management requirements. They tend to involve clinical discussion on individual treatment, self-management and prescribing decisions, as well as elements of patient education and peer support, all undertaken in a group setting. They have largely been delivered to patient groups with long-term conditions such as diabetes or asthma, or other shared health concerns.
When in-person care was restricted during the Covid-19 pandemic, some clinicians in the UK started delivering group consultations remotely over video. In general practice, many were supported by a programme commissioned by NHS England and Improvement (NHSE/I) and delivered by external partners Redmoor-ELC. The programme included training, webinars, a toolkit, specialist IT support, and opportunities to network with experienced clinicians, as well as an e-learning package. All this, in the context of a strong policy push to establish ‘digital first’ primary care.
What do we know from our research on video group consultations?
During the first year of the Covid-19 pandemic (2020-21), we conducted an interview study on video group consultations across 8 early adopter general practices in England, as part of a large research programme on video consulting (1-3). Video group consultations were delivered in a range of clinical areas, such as asthma, diabetes, COPD, cancer, mild or long Covid, and vulnerable families with new babies. Under the same research programme, a survey of 809 NHS clinicians, managers and support staff across the UK indicated that half of respondents had set up video group consultations and about 100 of them had delivered group sessions by September 2020 (draft survey report available here). We also organised 3 co-design workshops with patients, NHS staff and NHSE/I programme partners, to understand what a good video platform might look like for video group consultations (with industry partners Site-kit) and what digital exclusion challenges this new model of care would surface (with applied digital inclusion agency Thrive by Design).
This work built on a previous NIHR-funded project on in-person group consultations for young people with diabetes in socio-economically deprived settings (2016-2020). We began this project with a large evidence synthesis, which foregrounded four over-arching principles driving sustained group engagement: a) emphasis on self-management as practical knowledge, b) affinity between patients; c) safe, life-stage appropriate care; and d) balance between group and individual needs (4). Drawing on these principles, we co-produced a new model of in-person group-based care for young people, which was implemented over 2 years in 2 hospital sites, and evaluated the service re-design effort using a formative and summative approach (5, 6).
Variation in use of the term ‘video group consultations’
The term ‘video group consultations’ is often used inconsistently, to refer to different types of remote group-based care which does not always include clinical care provision (e.g. informational sessions); however, this is not dissimilar to one-to-one consultations which are sometimes focused on informational or educational needs, rather than strictly on clinical content.
Video group consultations are ideally facilitated by 2 (or more) healthcare staff, one taking the role of group facilitator, and the other providing clinical input (although the set-up varies between practices depending on available resources). Patients join the video call (mostly on MS Teams) and consent to a confidentiality statement. After a brief introduction, the clinician goes around the ‘virtual’ room for a short consultation with each patient in the group setting, drawing on clinical details (e.g. blood tests or other results) that are displayed on the shared screen (sometimes but not always, depending on the patient group). Sessions usually continue with open discussion and questions on key concerns and self-care needs, and end with patients consolidating learning and personal goals. Although this format is typically recommended in training sessions, it is not always feasible or clinically appropriate, so in practice different formats have been piloted to meet different needs.
Clinician and patient experiences
Clinicians suggest that being able to consult through a combination of peer sharing and clinical input, enables patients to become more involved with their self-care and improve long-term outcomes. There is also potential for augmenting the clinical relationship, as clinicians learn from how patients interact with each other and share experiences living with illness (often talking more openly about what wrong with self-care). Patients value ‘human connection’ and are surprised by how much input they gain and how their own experiences can help their peers. Some told us they find it easier to access their practice remotely, although others do not have the right equipment or confidence to engage online, or prefer not to share with other patients in a group setting.
Although there is an expectation that group consultations would lead to increased cost- and time-efficiency, healthcare staff suggest this is offset by the effort needed for set-up, preparation, co-ordination and delivery. Training on remote group-based care is highly valued and clinicians find whole-practice support important for sustained implementation, given the need for operational
alignment and changes to staff roles and professional norms. Group consultations do not magically solve current challenges with service provision and capacity in the NHS, and bring with them a different set of complexities. Still they may work as another tool in the toolbox to meet locally-relevant patient needs and service priorities.
Despite much enthusiasm, implementation of (video) group consultations remains ad hoc and we do not yet understand if and how they can become part of routine care in general practice. In answer to my GP colleague’s question: clinicians are definitely delivering (video) group consultations, but there is still much to learn about good value remote group-based care, about embedding and sustaining this in different contexts, and about minimising risks from delivery at scale.
We are shortly embarking on a large NIHR-funded project to better understand how (and whether) group consultations can be co-designed and conducted remotely to support patients with chronic conditions in general practice. Using mixed methods, we will examine patient and staff experiences from different perspectives, including implications for access, satisfaction, safety, efficiency, healthcare utilisation and value for money. Our focus is on understanding complex, dynamic interdependencies in implementation and scale-up, including potential for improved patient care, staff wellbeing and service improvement.
Get in touch if you’d like to find out more (firstname.lastname@example.org).
Acknowledgments: The work mentioned in this blog was funded by the Health Foundation, the NIHR HS&DR programme, HEIF and MRC P2D.
1. Greenhalgh T, Rosen R, Shaw SE, Byng R, Faulkner S, Finlay T, et al. Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics. Frontiers in Digital Health. 2021;3(103).
2. Papoutsi C, Shaw S, Greenhalgh T. Implementing video group clinics in general practice during Covid-19: qualitative study BJGP. under review.
3. Shaw S, Hughes G, Wherton J, Moore L, Rosen R, Papoutsi C, et al. Spread, scale up and sustainability of video consulting services: findings from a mixed methods comparative case study of policy in England, Wales, Scotland and Northern Ireland during the Covid-19 pandemic. Frontiers in Digital Health. 2021.
4. Papoutsi C, Colligan G, Hagell A, Hargreaves D, Marshall M, Vijayaraghavan S, et al. Promises and perils of group clinics for young adults living with diabetes: findings from a realist review. Diabetes Care. 2019;42(5):705-12.
5. Papoutsi C, Hargreaves D, Hagell A, Hounsome N, Skirrow H, Koteshwara M, et al. Can group clinics offer a better way to meet the complex health and social care needs of young adults with diabetes in an ethnically diverse, socioeconomically deprived population? NIHR journals. under review.
6. Papoutsi C, Hargreaves D, Colligan G, Hagell A, Patel A, Campbell-Richards D, et al. Group clinics for young adults with diabetes in an ethnically diverse, socioeconomically deprived setting (TOGETHER study): protocol for a realist review, co-design and mixed methods, participatory evaluation of a new care model. BMJ Open. 2017;7(6):e017363.
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Dr Gemma Hughes, Health Services Researcher in the IRIHS Team, writes on current research led by Dr Sara Shaw and funded by the Health Foundation.