Shared medical appointments in the UK

Dr Rob Lawson

The definition of a shared medical appointment (SMA) is when multiple patients have an appointment at the same time (typically about 90 minutes in length) with a team of healthcare professionals representing different professions. During an SMA, participants receive education, participate in group discussion with other patients, and interact with a multi-professional healthcare team. The primary aim of the model is to improve patient health and wellbeing and to empower patient self-management. The additional aims are to increase patient and clinician satisfaction and to reduce waiting times and return rates.

There are a range of advantages for both patients and clinicians.

For patients:

  • Improved quality of care and access to care
  • Extra time with own doctor and more relaxed pace of care
  • Peer support and feedback from patients with similar conditions
  • Multidisciplinary care from a range of providers
  • Answers to questions they might not have thought to ask (because others in the group ask)
  • An additional healthcare choice
  • Greater self-management education, health literacy and attention paid to psychological issues

For clinicians:

  • Increased physician productivity, quality and time/cost effectiveness (what would have been a 3 hour session for a clinician is reduced to 1 hour)
  • Better management of waiting lists (in addition there is a reduction of return visits)
    Reduced repetition of information/advice
  • An opportunity to get off the fast-paced treadmill of individual visits Improved clinical income through cost containment
  • A chance to get to know patients better in an interactive setting, a reduced burden of care and increased clinician satisfaction
  • Real help from the multi-disciplinary team with the opportunity to coordinate multi-disciplinary care plans

SMA-imageSMAs hold particular promise for patients with low levels of health literacy, such as the aged, migrant groups and lower socio-economic individuals, for whom treatment has shown to be problematic. It might be anticipated that the additional time, patient education and peer support in such settings would ensure greater understanding of self-management and treatment adherence, thus leading to better patient outcomes.

Although the system has been established in the more privatised US health care system and more recently in Australia, it has just as much relevance in more Government-managed systems where costs and time-savings are vital for ongoing central health support.

Potential barriers

  • Confidentiality – in 17 years of practice in the US there has been no complaint about breach of confidentiality. A privacy statement/confidentiality waiver is signed at the start of each session.
  • Different culture in the UK to America and patients more reticent to engage – the evidence in Australia suggests otherwise. Only 1 patient has withdrawn from the Australian pilot on the grounds that it was not ‘his thing’.
  • GPs/Doctors resistant to changing their ways – once a GP/clinician has tried it the trend has been to increase the number of SMAs and none have pulled out. There has been a 100% satisfaction rate for such providers.
  • Problems attracting patients – the response rate in the US to an invitation to attend an SMA has been 90% if received from a doctor, 50% from a nurse and 10-20% from admin staff. There is a 98% satisfaction rate for attending patients.
  • Government engagement (lack of) – in Australia there has been acceptance and now SMAs are included in its Medicare programme.

Some examples of SMAs:

  • Diabetes – type I and type II, adults and children, male and female separately
  • Liver disease
  • Pregnancy
  • Asthma
  • Chronic heart failure
  • Diabetes foot exam
  • Diabetes management
  • Pre-diabetes
  • Hypertension
  • Lifestyle wellness
  • Men’s health – including prostate disease and erectile dysfunction
  • Multiple sclerosis
  • Osteoporosis
  • Parkinson’s disease
  • Skin – acne in males and acne in females
  • Stroke and TIA
  • Weight management
  • Menopause

More information on implementing SMAs in your practice can be found in the document below:

SMAs implementation - Generic template [PDF] 

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