Group clinics: the future of nurse led planned care?
Since 2018, NHS England’s Primary Care and Community Nursing team have championed the spread of group clinics. Their work, undertaken in partnership with The Experience Led Care Programme (www.elcworks.co.uk), was awarded The Health Service Journal (HSJ) Partnership Award for Best Education Programme in 2020 for support provided to train teams to run face to face group clinics. And in 2021, the same partnership won two HSJ Partnership Awards for the National video group clinic (VGC) learning programme, co-developed and delivered to over 500 GP practices across 3 months during 2020 Lockdown.
They remain at the forefront of work to spread and embed group clinics in England and see group clinics as fundamental to the future of person-centred primary care and community nursing and a powerful vehicle to support nurses in the community to lead improvement.
The team are currently working on a vision for primary care and community nursing. Group clinics are likely to be an important building block. Join our webinar this lunchtime and hear more from the team on 23 May 12.30 – 13.30
https://www.eventbrite.co.uk/e/group-clinics-the-future-for-nurse-led-planned-care-tickets-863090094707?aff=oddtdtcreator
The rationale for nurse led group clinics
There are three reasons why it makes sense for group clinics to be the mainstay of nurse led care.
1. Person centred care
Nurse led care must be person centred.
Group clinics are formally recognised in NHS England’s 2023 guidance How to improve care related processes in general practice as a “personalised care approach to long term condition management” (NHS England, 2023).
A recent systematic review of group clinics (Wadsworth et al 2019) explored the impact of the model on personalisation. They concluded that compared to usual care (one to one appointments), group clinics lead to measurable improvement in patients’ trust in their clinician. Patients who attend group clinics also perceive the quality of their care as higher.
Moreover, they report that group clinics are more engaging and empower them as more active participants in their own healthcare, whilst at the same time improving access and healthcare efficiency.
In their systematic review, Graham et al (2021) found that patients report group clinics being a positive and a supportive environment to learn about self-care. Carers reported improved communication between carer and patient after group clinics.
2. Improved quality of long-term condition management
Most people with chronic health issues are supported mainly by nurses.
Group clinic appointments have been subject to many systematic reviews over the years. The best evidence of impact of group clinics is found in research on Type Two Diabetes pathways where most often randomised controlled trials suggest the following positive impacts of group clinics, including:
• Improved clinical biometrics – in particular HBA1c and blood pressure (Kirsh et al 2017)
• Improved knowledge of diabetes (riley et al 2010)
• More patient-initiated behaviour changes (Dickman et al 2011)
• Improved quality of life for people living with Type Two Diabetes (Trento et al 2010)
There are also important system benefits that nurses can realise for the NHS:
• Reduced A&E visits amongst vulnerable people with diabetes (Clancey et al 2003)
• 18% increase in percentage of patients achieving National Institute for Health and Care Excellence (NICE) recommended eight care processes in Type Two Diabetes within 12 months (Gandhi et al 2019)
• Greater access to one-to-one appointments and improved access for everyone (Birrell et al 2018)
• Clinician time efficiencies; a 0.5 FTE advanced nurse practitioner released for every 500 people seen in diabetes group clinic (Gandhi et al 2019)
• Reduced waiting times for annual diabetes reviews from 6 weeks to 2 weeks (Gandhi et al 2019)
3. Autonomy, retention and joy in clinical practice
Nurses need to enjoy their clinical practice.
Graham et al (2021) reports that clinicians identify several benefits of group clinics, including: more comprehensive patient-led care, the value of peer-to-peer support, reduced repetition, and improved clinic efficiency. Lynch (2022) found that group clinics restore joy to repetitive, monotonous, clinical work through deeper connection to their patients. Having control and autonomy to incorporate group clinics into existing clinical pathways was highly motivating because it engendered a sense of belonging and feeling valued and trusted by their employer.
In fact, Welsh clinicians described having the autonomy to improve simple clinical interventions that were not adding value to patient care nor utilising their clinical skills was a “relief”. They shared how group clinics aligned with their professional values. They expressed pride and joy in the difference group clinics had made to patients’ experiences and to the quality of their own working lives.
Participants described how switching to video group clinics meant that they continued to work rather than shield during Covid 19, and how their group clinic experiences had changed their decision to leave their post or retire early.
It is well documented that the ability to exert personal influence over the quality of clinical work is key to successful workforce retention. Lynch’s evaluation is amongst the first to document improved nurse retention as a benefit of group clinic adoption; a benefit that other researchers have postulated would emerge (Thompson-Lastad et al 2020).
Hear national nurse leaders discuss their vision further today:
Thursday 23 May 12.30 – 13.30
Group clinics: the future for nurse-led planned care. Book here.