Group clinics: coproducing outcomes with people and communities
Group clinics are recognised as a way of embedding personalised care for people with long term conditions within Modern General Practice (NHS England 2023). Trials of group follow up directly compared with normal care have shown improvements in diabetes biometrics (Kirsch et al 2017), with more health-related behaviour changes (Dickman et al 2011), improved knowledge of diabetes (Riley et al 2010) and improved quality of life (Trento et al 2010).
With the promise of improved quality of care, combined with clinician efficiency gains (Gandhi et al 2019), group clinics offer real promise.
And what if group clinics could offer even more? The conversations between clinicians, people and their families are the DNA of the NHS. When DNA mutates, transformation happens. Group clinics mutate the DNA of those clinic conversations towards co-production – and this could be their ultimate benefit.
What is coproduction?
Coproduction is a cultural norm that the NHS has aspired to embed for some time. Statutory Guidance Working in Partnership with People and Communities (https://www.england.nhs.uk/get-involved/involvementguidance/) issued in July 2022 calls on the NHS at all levels to follow 10 guiding principles. These apply equally in the context of delivering clinical care and group clinics tick all the boxes.
The 10 principles are:
1. Centre decision making and governance around people and communities
2. Involve people and communities at every stage and feedback how their involvement has influenced activities and decisions
3. Understand communities’ needs, experiences, ideas and aspirations for health and care, engaging to explore if changes are working
4. Build relationships based on trust, especially with marginalised groups and those affected by health inequalities
5. Work with Health Watch, the voluntary, community and social enterprise sector
6. Provide clear and accessible public information
7. Use community centred approaches that empower people and communities. Connect with what is already working
8. Have a range of ways for people to take part in health and care services
9. Tackle system priorities and service reconfiguration in partnership with people and communities
10. Learn from what works. Build on the assets of all health and care partners, including the networks, relationships and activities in local places.
At a recent webinar (https://www.elcworks.co.uk/webinar-highlights/), Paul Gavin, Joint Deputy Director Equalities and Involvement, People and Communities Directorate, NHS England recognised that group clinics were very much part of his team’s agenda and that in 2024/25, they wanted to work in partnership with ICBs to explore how these 10 principles can be embedded by harnessing group clinics.
How to embed coproduction through group clinics
Based on ELC’s experience of working with teams to embed group clinics, we can imagine clinical teams, organisations and integrated health and care systems harnessing group clinics to embed coproduction in three stages – each fundamental to adoption of coproduction at scale. These are set out below and in Figure two.
STAGE ONE: clinicians change their mindset and behaviour: because they review and work with people in group clinics, clinicians gain lived experience of sharing power and coproducing solutions. They find it rewarding and observe people regaining control of their health and their lives. Teams realise that group clinics also save them time – and that personalised care is sustainable. This excites them and moves clinicians towards a coproduction mindset.
STAGE TWO: clinical teams co-produce care with communities: clinical teams gain confidence delivering group clinics. They realise that the model opens the door to collaboration and coproduction with the voluntary, community and social enterprise sector. They engage with local partners to find ways to co-design and coproduce routine clinical care with their partners. Volunteers with lived experience act as group clinic facilitators. Everyone collaborates and aligns to support people to create health, especially marginalised groups and those affected by health inequalities. Community partners, the NHS and other statutory providers evidence that their work is realising efficiencies and people are keeping well. The word spreads that working this way is sustainable and produces better outcomes.
STAGE THREE: coproduction is business as usual everywhere: the learning gained from coproducing routine clinical care leads to a change in mindset and culture across the whole system. Everyone starts from the premise that coproduction is “The way we do things around here”.
Clearly this transition will take time and committed leadership. The People and Communities Directorate at NHS England is determined to sow the seeds. If you are interested in learning more, contact me for more information:
Georgina Craig georgina@elcworks.co.uk
Listen to Paul Gavin, Joint Deputy Director Equalities and Involvement, People and Communities Directorate, NHS England and Olivia Butterworth, Director, All About People discussing group clinics and their contribution to coproduction here:
https://www.elcworks.co.uk/webinar-highlights/