I evaluated a pilot of in-person Shared Medical Appointments (SMAs) for multimorbidity implemented by Devon Doctors and Plymouth Marjon University, with funding from The Health Foundation’s Innovating for Improvement programme.

SMAs are a means of a clinician seeing more than one patient simultaneously within an allocated timeslot. They are often thought of as a way of saving resource and clinician time, with potential to help deal with patient demand and the burden of multimorbidity in primary care.

Patients felt that the SMAs supported new, more holistic ways of conceptualising their conditions. Staff valued the format and the time it offered for patient engagement.

Devon Doctors combined forces with Plymouth Marjon University and Evalesco Consulting to design and deliver SMAs in general practice for groups of eight patients, lasting up to two hours every three weeks. The original focus of the appointments was pain management, but this was soon adapted towards multimorbidity management, in response to patient need.

The SMAs were supported by a project manager and administrator and delivered by a GP and health and wellbeing specialist, who is a trained physiotherapist. They consisted of psycho-education and health promotion, clinical advice, opportunity for social time and mutual support.

A unique element of the SMAs was the support offered by a clinical psychologist, who provided reflective facilitation to the clinicians and the patients themselves. The clinicians were encouraged to record reflexive voice notes at the end of each session, as a mode of debrief and learning.

Each patient attended on average 4.6 shared medical appointments during the project and the average estimated saving per patient was £406.20 over 12 months.

My evaluation, utilising focus groups, found high levels of satisfaction among both patients and staff. Patients felt that the SMAs supported new, more holistic ways of conceptualising their conditions. Staff valued the format and the time it offered for patient engagement versus traditional ten-minute appointments.

Both patients and staff said how this mode of appointment delivery and the interprofessional and reflective nature of SMAs helped reduce their sense of personal and professional isolation.

‘It is nice to see others with similar conditions as you feel less isolated and it makes you feel like you are not on your own with it, as often it can be quite debilitating’ – Patient quote

The SMAs also made an impact on practice workload. For the patients seen, clinical contacts reduced by 35% compared to the 12-months prior to the pilot. Out-of-hours services contacts were reduced by 14%, medication queries reduced by 67%, and emergency department attendances went down by 63%.

Each patient attended on average 4.6 shared medical appointments during the project and the average estimated saving per patient was £406.20 over 12 months. The implementation team estimates that an SMA with eight patients can save 28 GP appointments over 12 months.

As part of the evaluation of SMAs, the team and patients underlined some key ingredients to consider when implementing SMAs in general practice, which included:

• an accessible venue that was neither too small nor too large, with access to the toilet nearby
• a dedicated note taker to record the session and key themes and actions
• visiting experts, e.g. special sessions on mental health or diet
• internet and IT access to medical records during sessions
• the ability to print from the room, especially scripts
• a screen and chairs (or access to another room) for one to one private meetings if required
• presentation equipment such as flipcharts or projectors (for instance, the patients demonstrated in the focus groups how well the flipchart had worked in helping them to map priorities)
• and refreshments such as tea, coffee and water for the social breaks.

Overall, SMAs gave patients the chance to make sense of and explain their own individual needs, and facilitators could respond to the needs of the group holistically over time during regular appointments, upholding patient-centredness and continuity of care. For more information about the SMAs and the evaluation, please contact maria.kordowicz@kcl.ac.uk.

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