Could shared medical appointments help the NHS and patients?

In medicine, the private one-to-one consultation is sacrosanct.

Yet shared medical appointments have been used successfully for years at the Cleveland Clinic in the US. Patients appreciate them. They compare experiences with other patients, learn from their questions, gain more advice than they might otherwise, and improve their understanding of their symptoms.

For the hospital, the gains are seen in improved outcomes, higher patient satisfaction, dramatically reduced waiting times and lower costs.

Here, then, is an innovation that could help the NHS, caught between rising demand and squeezed budgets, which is leading to longer waiting lists and growing discontent. By sharing appointments, more patients could be treated more quickly, reducing waiting times, saving costs, yet raising standards of care.

They have been tried by GPs in Edinburgh, Sheffield and Newcastle, following the lead of doctors in the US and Australia. As a surgeon, I can see the potential benefits in bringing together patients undergoing the same procedure for pre- and post-surgical care.

Shared appointments are not appropriate for all patients or all conditions. They should always be offered, never imposed, and patients would always retain the option of a one-to-one consultation, if that was what they preferred. There might, however, be trade offs. Patients might be offered a one-to-one consultation in four weeks or a shared appointment in 48 hours.

They can yield real benefits in the routine care of chronic illnesses such as asthma, diabetes and heart disease, where patients can learn from and motivate each other. We already know the secret of Weight Watchers’ success lies in creating peer pressure among group members who compete to see who can shed most pounds. Alcoholics Anonymous similarly allows people to share a problem and begin to tackle it together. There are websites such as PatientsLikeMe which connect people to others with similar conditions.

However, shared medical appointments work differently from self-help groups. Each patient is examined by the doctor, diagnosed and prescribed treatment in exactly the same way as they would be in a one-to-one consultation. The benefit for the patients comes from observing how the other patients are managed, or manage themselves. In one example, a patient with heart disease was persuaded to get on an exercise bike by hearing about a teenager with a heart condition who had a passion for basketball.

The doctors are spared having to repeat the same information a dozen times a day, saving time and costs. Whereas a heart patient might require a half-hour appointment for a routine follow-up visit, with a shared appointment six or seven patients could be seen in 90 minutes.

In certain cases, only part of the appointment might be shared. For example, in a typical shared appointment for female patients at the Cleveland Clinic, the doctor performs breast and pelvic examinations and discusses test results in private, while the remainder of the appointment includes the other patients.

Given these benefits, it is surprising that shared appointments have not been taken up more widely. In an article in the New England Journal of Medicine, Professor Kamalini Ramdas of London Business School and I suggest there are four principal reasons: the lack of rigorous scientific evidence of their value, the absence of easy ways to pilot them, missing incentives and lack of awareness among both patients and clinicians.

There is another reason. Innovations in healthcare typically take 17 years to spread, from proof of principle to widespread uptake. And this is an average – some take decades.

We need smart ideas – and disruptive innovators to implement them – if we are to improve the outlook for patients and for the NHS. Shared appointments is an idea worth pursuing.

Lord Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London. He was a Labour health minister from 2007–09.

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Could shared medical appointments help the NHS and patients?