National Evaluation of Group Consultation Models
Research type
Research Study
Full title
National Evaluation of Group Consultation Models: Sir Jules Thorn Trust Virtual Hub
IRAS ID
275366
Contact name
Fraser Birrell
Contact email
Sponsor organisation
Newcastle University
Duration of Study in the UK
2 years, 10 months, 27 days
Research summary
Research Summary:
This study aims to assess the value of group consultations in the UK. This will be compared to usual care and mapped to healthcare's quadruple aim looking at:1. Patient care and satisfaction
2. Patient outcomes
3. Value for money
4. Staff experienceDue to the COVID-19 crisis the initial focus will be on virtual group consultations (VGC). We plan to include face to face group consultations (GC) and hybrid (face to face with virtual extension option) as soon as it is safe to do so.
To achieve these aims the study will investigate 4 areas:
1. Routine activity and outcome data, showing group consultation value based on treatment targets for individual diseases (e.g. blood pressure <140/80)
2. Cost effectiveness
3. Interview-based study to explore patient, staff and student views
4. Educational element: for medical students, nursing/allied health students and qualified doctors to help integrate this new consultation style in teachingThe study involves 4 groups:
A. Main cohort (cohort A) patients attending VGC/GC and others not attending VGC/GC. Follow up over time using routinely collected anonymous information.
From this main cohort there will also be the option to be involved in the following:
B. Participants consenting to complete questionnaires and provide with identifiable detailed information
C. Patients and staff consenting to interview
D. Participants (students and patients) consenting to provide further data for educational researchThe study will take across multiple sites in England, however initially the interview section of the study will only take place at Gateshead Health NHS Foundation Trust, which also has NIHR Applied Research Collaboration North East & North Cumbria project funding.
Summary of Results:
This study aimed to examine 4 key elements. These complement the training and support element of the Newcastle University Group Consultation Virtual Hub.
1. Routine activity and outcome data
The fatty liver pilot study at Gateshead (21 people participated) showed improvements at 6-9 months (publication in preparation):
- 52% reduced their body mass index
- 40% lowered blood pressure
- 61% lowered total cholesterol
- 33% reduced long-term blood sugar (HbA1c)
- 14% improved liver function tests
- 69% reduced the liver stiffness measurements on liver ultrasoundIn summary, virtual groups improved patients’ quality of life, biochemical measures metabolic risk factors and liver stiffness.
We have published papers showing:
- high remission rates for inflammatory arthritis (Russell Westhead et al, 2020)
- feasible scaling (Jones at al, 2019)
- group consultations can meet healthcare’s quintuple aim: delivering good outcomes, high patient and clinician satisfaction, cost effectiveness and educational value (patient co-authored; Birrell et al, 2021) 2. Cost effectiveness Has been demonstrated across whole pathways, such as those initiated by Menopause Virtual Engagement events, hosted by the Homerton Hospital:- eligible women were invited electronically for a Whole Primary Care Network (10-12 practices)
- 100-500+ patients attending an initial session
- only 20% required any further input through smaller group consultation sessions
- shown to be transferable to other sites, including Cheshire & Lanarkshire 3. Interview-based study to explore patient, staff and student views This included the fatty liver pilot study at Gateshead. Qualitative data from patients highlighted the benefit of peer support and motivation, as well as improvement in health literacy. Staff felt the sessions were well organised and easy to deliver.
4. Educational element: for medical students, nursing/allied health students and qualified doctors to help incorporate this new consultation style into teachingThis has included work with In2MedSchool (website here), whose Accelerator programme has engaged sixth form students from disadvantaged schools across the country. Schools were selected for never having had any students successfully apply to medical school. Students were engaged through virtual group consultation modelled sessions and supported to conduct projects addressing inequality in their own communities. The programme grew from 15 schools in 2023-24 to 80+ schools in 2024-25. Popular events were held to present projects and demonstrate learning- such as, Hackathons at Imperial College and Birmingham. Many students from disadvantaged backgrounds were successful in gaining places at medical schools ,and other health-related disciplines for the first time.
A selection of student and junior doctor tutors were invited to participate for more detailed data collection, but small the numbers that agreed to take part, limited the potential value of this additional data There were (5 medical students and one junior doctor from six different medical schools; none were members of the British Society of Lifestyle Medicine; but with some knowledge of Lifestyle Medicine & Group Consultationsdata summary here). The key findings were that consent processes and data collection needed to be light touch and agile. These findings were triangulated by direct feedback from in person groups for menopause and pain at Alnwick Medical Practice, where consented patients were unable to be uploaded due to the withdrawal of Research Delivery Network support.Subject recruitment to the study was limited, however, the study did raise the profile of group consultation models. It resulted in:
- Dr Emily Symington securing an NIHR In Practice Fellowship. Her feasibility study will assess whole pathway implementation of the virtual engagement group consultation model for fibromyalgia
- Colin Stephenson’s PhD, funded by Northumbria University RDF Fellowship. He is focused on whole pathway implementation of the virtual engagement group consultation model for frequent attenders in Primary Care
- Virtual engagement events and group consultations being recommended in the NHS Menopause toolkit
- NHS England embedding group consultations in the 10-year plan
Conclusion: group consultations have great potential to deliver healthcare that meets the quintuple aim and are now being embedded across the NHS.REC name
Wales REC 4
REC reference
21/WA/0126
Date of REC Opinion
20 May 2021
REC opinion
Further Information Favourable Opinion