Recovering quality and outcomes framework: how group clinics work
In March, everything non-urgent is on hold. No one needs to ask, why? The focus is on the GMS Quality and Outcomes Framework (QOF). Group clinics are a way of delivering planned care that has been advocated since 2015. And yet, few practice teams have mainstreamed the practice. If practices did, next March might be a very different month – and a whole lot less stressful.
This is the tale of two teams who use group clinics to deliver QOF.
Let’s start with Laura Ireland. Laura works in the Moatfield Surgery in East Grinstead where she is Practice Nurse and Allied Health Professionals Manager. Laura loves working with her patients to help them modify their lifestyle. See what her patients say about Laura and her diabetes group clinics here:
Laura and her team trained with Experience Led Care (ELC) www.elcworks.co.uk in 2018. By her own admission, Laura “did exactly what Georgina told us to do” and succeeded. Now Laura works as one of ELC’s expert clinician mentors, co-delivering our simulation and advanced clinician skills training modules. She is a complete star.
In late September 2023, Laura explained that she had booked the Town Hall for two days in October and planned to invite all her COPD patients to come to group clinics for their “Winter MOT” (alias QOF review). The team would also administer any outstanding immunisations. Because of the timing, Laura took the opportunity to make sure everyone had a winter plan, an emergency pack and knew what to do if they had an exacerbation.
This was the first time that Laura had done COPD group clinics. It was also a first for her patients. Not as many people came as she hoped. The team learnt a lot and made good in-roads into their patient register nonetheless. People loved the sessions. They did not want to leave at the end – and of course, all their QOF boxes got ticked.
Laura presented this work last week at https://www.bestpracticelondon.co.uk. The day after, the practice confirmed that the COPD QOF was in the bag for 2023/24. Laura was delighted – and so was I! This really demonstrates how proactively managing and supporting people pre-winter helps keep them well. I am following up with Laura today to see whether we can audit the number of COPD-related hospital admissions this winter compared to last to see if this work had a wider impact.
At the same conference I also worked alongside another superstar from the group clinic community – Dipti Gandhi. Dipti is Managing Partner at The Brigstock Medical Practice in Thornton Health South-West London. Dipti is a clinical pharmacist and Diabetes Clinical Lead for the integrated care board (ICB).
In Brigstock, clinical pharmacists and nurses have been managing chronic disease for many years – long before the ARRS roles were imagined. Dipti introduced group clinics, supported by ELC, in 2018. During Covid, Dipti switched to video group clinics (VGCs) to support continuity of care. Although she prefers working face to face, she saw its potential.
Listen to the amazing feedback from Brigstock patients here: https://youtu.be/ZhXgOdT2FZQ?si=WGwQo-BiYf4AAwOd
When I heard about Dipti’s work with QOF, and the degree to which she had scaled up her practice, I wanted to document it. In 2019, Dipti and I captured her first 12 months’ results in a peer-reviewed paper in The Journal of Medicine Optimisation https://www.pmhealthcare.co.uk/uploads/imagelib/pdfs/Journal_articles_by_issue/JoMO%20Sep%202019/Diabetes%20group%20consultations%20in%20Brigstock%20Medical%20Practice.pdf
This remains one of the few published studies that document the implementation of group clinics in English general practice. It provides valuable insights about the benefits that teams realise very quickly. The switch:
- Helped the team reduce nurse and clinical pharmacist time spent managing diabetes from 24 hours a week to 8 hours (a 0.5 FTE clinician)
- Reduced waiting times for a diabetes review from six to two weeks
- Reduced DNAs from a practice average of 11.7% to group clinic average of 5.94%
- Led to an 18% rise in compliance with NICE guidance as measured by QOF
- Led to improvements in HBA1c and blood pressure, with 10% of group clinic patients losing weight.
These results align with the wider evidence from randomised controlled trial of group clinics versus one to one follow up appointments amongst those with Type 2 Diabetes.
More than anyone I know, Dipti and Laura have proved that group clinics are part of mainstream service delivery.
So, as we move into April, ask yourself, how do I want to feel next March?
If you would like to feel joyful and celebratory, give group clinics a go.
Get in touch with the ELC team so that you learn from Laura, Dipti and others who have made the switch.
Listen to Laura and Dipti presenting their work here: https://www.elcworks.co.uk/webinar-highlights/
Get in touch with Georgina for more information about ICB funded group clinic training and support in your area: georgina@elcworks.co.uk
