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Meet the team: TOGETHER+ group clinics

Also:

  • Sarah Finer (Clinical Senior Lecturer in Diabetes, Queen Mary University of London, and Honorary Consultant in Diabetes, Barts Health NHS Trust)
  • Trish Greenhalgh (Professor of Primary Care Health Sciences, Department of Primary Care Health Sciences, University of Oxford)
  • Martin Marshall (Professor of Healthcare Improvement, University College London)
  • Ann Hagell (Research Lead, Association for Young People’s Health)
  • Murali Koteshwara (Consultant Physician in Endocrinology & Diabetes, Central Middlesex Hospital)
  • Emma Cartwright (Patient, experienced in peer support)
  • Lynsey Choules (Patient representative)
  • Omar Siddik (Youth worker)
  • Working in collaboration with Diabetes UK

Challenge

Diabetes prevalence (both type 1 and 2) is steadily rising in young adult groups, who face a range of poor clinical and psychosocial outcomes, including widening inequalities and significant barriers to service engagement. New models of care are needed to support this patient group.

Group clinics are increasingly gaining traction as a way to engage patients, improve clinical outcomes and support self-management, in the context of rising healthcare costs and diminishing resources. Compared to usual one-to-one appointments, group clinics signify the importance of storytelling, shared lived experiences and supportive peer relationships. However, as the Q Lab essays suggest, organising services at the intersection of traditional clinical and peer support models creates new tensions and risks, requires a different skill-set for staff and assumes new ways of engaging voluntary and charitable organisations [1].

Although there is a large literature on group clinics for adults with chronic conditions (usually White, middle-aged or older patients), there is little emphasis on the distinct needs of younger patients (aged 16-25) with diabetes (type 1 and 2). Established peer support models are not adequately considered in research on group clinics and there is little practical guidance to support clinical care delivery that relies on positive peer relationships.

 

Idea

This project aims to develop implementation guidance to support healthcare staff in facilitating meaningful and supportive peer relationships as part of group-based clinical care for young adults with diabetes (aged 16-25) in diverse, deprived NHS settings. As emphasised in the Q Lab report, there are tensions between standardising peer support and allowing bottom-up, authentic solutions to emerge [1]. We do not intend our implementation guidance to be prescriptive, but to set out principles, stories, examples, ideas, strategies and transferable lessons. For example, we will provide suggestions on how to be adaptive and responsive to patient needs in group clinics, or how to think creatively about sustaining a safe and fun atmosphere.

Experience from our ongoing work highlights that peer support does not emerge automatically within group clinics. A proactive approach is required to address difficulties and unpredictable dynamics. This includes working with ‘challenging’ behaviours that often seem counter-productive but may lead to beneficial outcomes if managed appropriately. Our pilot work also emphasises that healthcare professionals delivering group clinics have a range of training needs in order to be able to harness and facilitate peer support effectively.

To develop guidance by foregrounding practical experiences of setting up peer support in group clinics, we will:

  • Draw on qualitative interview and observation data from the researcher-in-residence evaluation of our ongoing feasibility study on group-based diabetes care for young adults piloted in an East London NHS Trust.
  • Analyse successes and failures to develop transferable lessons on how peer support can be meaningfully embedded in group clinics.
  • Draw on existing academic and grey literature, including example guides on peer support provided by the Q Lab, quality improvement frameworks and transferable knowledge from other sectors.
  • Organise peer support-focused facilitation training for clinical teams to reflect on experiences and evaluation findings.
  • Provide improvement coaching so that clinical teams implementing group clinics can identify systematic ways to address ongoing challenges in harnessing peer support.
  • Organise co-design workshops with patients, health professionals, group facilitators and youth workers, to synthesise learning and collaboratively develop consensus on the implementation guide.
  • Develop and test our resources further with an additional North-West London hospital.
  • Create professionally designed outputs and carry out dissemination with the help of patient participants (e.g. at Peerfest).

Guidance will provide useful lessons on how to harness person-centred peer support to maximise the benefits of group clinics premised on a sense of equality and equity. This fits with the Q Lab vision: ‘…to create spaces in which to explore these areas of complexity, and to provide support to help people navigate them’ [1].

 

Anticipated benefits

Our implementation guidance will:

  • Support innovative clinical care models based on peer relationships between young adults from ethnic minority groups and socio-economically deprived backgrounds.
  • Improve patient experiences and engagement with an alternative clinical service, where young adults can feel less vulnerable – currently, we understand little about how group clinics are best delivered.
  • Support healthcare staff in harnessing peer relationships in group-based care. This will fill a significant training need in a setting where one-to-one interactions are the norm. By equipping staff with expertise in youth peer support, it is more likely that they will experience their role in group clinics as rewarding and fulfilling.
  • Provide transferable and scalable knowledge to the Q community for testing and implementation in different settings. We will build on the Q Lab reports and write up our findings for different audiences, with recommendations transferable to other long-term conditions and age groups.

[1] Q Lab (2018). Learning and insights on peer support. Available at: https://qlabessays.health.org.uk/essay/learning-and-insights-on-peer-support/

How you can contribute

  • Has anyone else tried to implement group clinics for young adults with complex social and medical needs?
  • What have your experiences been and how did you facilitate interactions between group members?
  • What challenges did you face and how did you try to tackle them?

Reviewer feedback

This is a great project because…

The projects builds on learning from the Q Lab on Peer Support as well as wider evidence. We liked the co-design with young people that has already taken place.

By the time of the event we encourage the project team to think more about…

This is part of a larger research project, and it would be great to see more thought about how the specific learning from this aspect will be shared with the Q community, as well as how it relates to the overall project.

Comments

  1. An interesting project. Have you thought about enabling young adults who have been through your service to support the groups rather than healthcare professionals?

    1. Apologies for the slow reply as many of us have been out of the office. We have discussed this with the young adults currently participating in the group clinics - contrary to what we expected, they were not very keen to do this. They preferred to come to clinics organised by health professionals. If we are successful, one of the aims of our Q project would be to look at how to enable young adults to take a more active role in supporting others! Any suggestions would be most welcome.

  2. Really interesting idea. Our project is focused on the use of motivational interviewing and health coaching for children and teenagers struggling with weight issues and certainly can see some similarities in the approaches. (https://q.health.org.uk/idea/a-fitter-future-together-improving-our-response-to-childhood-obesity/#comments) Like your team,  we want to move away from solely focusing on traditional advice giving and more towards a model based on co-production and peer support. We look forward to hearing about the progress of your project.

    1. Your project sounds really interesting too. Especially co-production with children and families which is an under-researched area. Very much agree that we need to find creative ways to engage patients of all ages. It would be great to compare notes if our projects progress to the next stage - fingers crossed!

  3. I really like the idea of "group clinics" Have you seen the work of Maren Batalden who has written about something similar  - linking peer support, coproduction and a "flipping" of the normal paradigm of health care.  http://qualitysafety.bmj.com/content/early/2015/09/16/bmjqs-2015-004315.

    I have also done some work on transition, albeit in a mental health setting, http://positivepracticemhdirectory.org/children-young-people/the-transitions-group/ & https://www.scie.org.uk/socialcaretv/topic.asp?t=mentalhealthtransitions which explored this a few years ago. The Transition Group is still running and provides something as you describe and I particularly like the focus on 16 -25s.

    1. Hi Helen - thanks so much for commenting on our proposal. The Batalden et al paper is brilliant and we will be drawing on this heavily going forward. Your work in mental health transition also sounds very relevant to what we are trying to achieve so it would be great to connect if our proposal makes it to the next stage!

  4. Guest

    This is a really important area for development. Researchers at LSHTM have highlighted the challenges of this transition phase of care for people living with sickle cell disease and also reflected the importance of peer-to-peer support and guidance on lifestyle issues. I'm also aware of extensive peer-to-peer mentoring that has taken place across NWL for adults that started of with a focus on prevention of diabetes but has extended out to cover wider lifestyle and population health factors given the extensive overlap in contributing to a wider range of details. Happy to share contacts if you DM me.

    1. Thank you for the encouragement and really constructive comments! As you suggest we will follow up privately for more details about the LSHTM work and peer-mentoring in NWL, as learning from other conditions and populations will greatly enhance the value of our proposal.

  5. This is a well-thought out project on peer support. It is clear this project is built on a clear evidence-base and there are a range of skills in the team. The project will engage with young adults in a deprived area- a population not often mentioned in Q bids. This is an interesting model which if successful, could be spread to other clinics.

    1. Thank you so much for the positive comments Bethan – you are right that there is the potential for transferability to other clinics and to other chronic conditions. We are also keen to explore safety aspects in our implementation guidance.

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