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A group consultation trial in Greater Manchester is enthusing patients and lets nurses take the lead

Nurse-led group consultations are being trialled in Greater Manchester. 

Primary care leaders are trialling nurse-led group consultations across Greater Manchester as part of the primary care transformation programme.

What are group consultations?

Group consultations deliver clinical care in a supportive group setting. They replace one-to-one reviews and follow ups with patients. They are not peer support groups, group education or expert patient tuition; they are an alternative way to deliver planned clinical care.

The group consultations being trialled support 10-15 patients simultaneously. Each consultation lasts about 90 minutes, with the clinician present for half of the time. For the first 30 minutes, a group facilitator will talk with the patients to identify any questions they may have about their condition or their care. These queries will be written on a whiteboard or flipchart alongside each person’s main clinical indicators, such as their blood pressure or blood glucose levels.

The facilitator gives each question a theme to minimise repetition. When the clinician arrives, there is a short break to review patients’ questions and clinical results. For the next 45 minutes, the nurse consults each patient in turn while everyone listens and learns from each consultation. The clinician then leaves and in the final 15 minutes, patients reflect and commit to personal goals.

Productivity

I am a practice nurse at Donneybrook Medical Centre in Hyde and lead on the development of practice nursing in Greater Manchester and I will be participating in the first wave programme. Group consultation makes perfect sense. It frees up time for primary care nurses and delivers high quality care and outcomes in a way that is meaningful for the patients. It is exciting to explore this potentially more productive way of working. 

I have run self-help groups for people with chronic obstructive pulmonary disease. Although the group consultations are different, I am hoping that what I learned about listening and the power of sharing experiences will stand me in good stead for group consultations. Practice nurses will have a lot of freedom to decide how they want to use the skills they develop.

I plan to test group consultations for cancer survivors along with the centre’s Macmillan GP Mary Ann O’Mara. She says: ‘Practice nurses, with their considerable skills in chronic disease management, are ideally placed to support patients living with and beyond cancer. People affected by cancer often have more than one other long-term condition so it makes sense for them to have their cancer review with a nurse who knows them along with their other reviews. We also hope to combine clinician training in cancer with group consultations.’

Helping people gain control of their condition is the way to achieve change in primary care. Group consultations are an important part of the solution. In my role in Greater Manchester, I promote new nursing models which support shared learning and decision making along with communities. Group consultations will boost practice nurse development across Greater Manchester.

An ‘instantly rewarding’ way to practice 

The Alexandra Practice in Whalley Range, Manchester is pioneering nurse-led group consultations. Sam Campbell (pictured left), the GP lead for the programme, says: ‘I had a eureka moment when I heard about group consultations.

‘The process places the person at the centre of the consultation. Having a consultation with your nurse in the presence of other people means that you benefit from the informal peer learning that happens naturally in the room. It is powerful to witness. People experience a highly individualised interaction with their nurse alongside other patients. It is not just a consultation. People have a safe space to reflect and co-create strategies and outcomes with their clinician and peers.

‘Practising this way is instantly rewarding. In contrast to traditional clinics where time pressures mean that those in greatest need may get the least help, clinicians are change agents who support their groups to better understand things they did not grasp before. People are becoming visibly enthused and empowered to take control of their health and well-being right there in the room.

‘Starting with diabetes, our team has put in place a rolling programme of monthly nurse-led group consultations. We want Greater Manchester’s practice nurses to lead the way, and shape primary care and our community.’

‘Deepening the impact of the consultation experience’ 

Tracey Vell, associate lead for primary care for Greater Manchester Health and Social Care Partnership is championing practice nurse-led group consultations in Greater Manchester’s primary care transformation programme. She says: ‘Group consultations look like a useful way to produce great outcomes for patients while being cost effective and feasible for our current primary care workforce. We are working on a population model in Greater Manchester, organised around locality hubs.

‘Because group consultations are designed primarily to deliver clinical care, they offer a new way to nurse. By encompassing patient-to-patient sharing, we are deepening the impact of the consultation experience.

‘I would like to see every hub accessing this approach as part of their primary care toolkit. We hope this programme will embed pilots in all GM localities, and we want to evaluate their impact to inform roll out.’

 

To find out more about group consultations visit here


About the author

Louise Brady is clinical and strategic development lead for practice nursing across Manchester clinical commissioning groups 

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