NHS 10-Year Plan: real delivery innovation essential

Could shared medical appointments be the answer?

The UK government’s commitment to tackle major physical conditions and help prevent 150,000 heart attacks, strokes and dementia cases as part of the NHS’s new 10-Year Plan has been welcomed. But with staffing and extra funding still below the level experts believe is needed to deliver the plan, real innovation in healthcare delivery will be critical.

Kamalini Ramdas, Deloitte Chair in Innovation and Entrepreneurship, London Business School (LBS), is a long-time advocate of shared medical appointments – or group consultations as they are also known – and an international advisory board member of Shared Medical Appointments UK.

Professor Ramdas believes that shared medical appointments have “huge potential to deliver efficiency savings for the NHS and big benefits for patients – improved knowledge and compliance”.

“But”, says Professor Ramdas, “if patients and physicians are not properly educated about and incentivised to engage in shared medical appointments, this new initiative in healthcare – which has huge potential to lower costs and reduce waiting times – will never be able to grow to a new national default and shared appointments will continue to be offered only in passionate pockets while tremendous untapped value leaches out of the healthcare system.”

Shared appointments are relatively new to the UK. 250 GPs across the UK have trialled them in areas including London, Birmingham, Manchester, Sheffield, Newcastle and Berkshire, but they are already proving their worth in other parts of the world.

In the US, shared medical appointments have been on offer from some providers for more than 15 years. They are already the default at the Cleveland Clinic and they are being used in healthcare delivery for chronic conditions such as diabetes (Cooper University Healthcare).

Professor Ramdas and her research colleagues Ryan Buell at Harvard Business School and LBS PhD student Nazli Sonmez are also running a trial with the Aravind Eye Hospital, a world-leading eye hospital and the biggest in India, which delivers two thirds the volume of eye care delivered by the NHS for one hundreth of the cost.

What’s not to like? “Most doctors are afraid patients won’t like the idea,” Professor Ramdas explains. “But it all depends what you’re used to. Most people wouldn't demand one-on-one education for their children, but a one-on-one with the doctor is considered sacrosanct.

“When Airbnb first started, many were shocked at the idea of staying a night in a stranger's house, even though this was enabled by a third party. Now it's considered normal.”

The best way to encourage adoption, Professor Ramdas believes, is to give people a taster. “Let them try a shared appointment and tell them if they don’t like it they can have a one-to-one appointment soon after."

A common misconception is that shared appointments replace one-to-one attention. In fact, patients continue to receive one-to-one attention; the only difference is that they receive it in the presence of other patients with the same condition from whom they might also learn a lot about how to manage their condition.

“And importantly, the non-repetition of common advice means the health service stands to save time and money, cutting costs and waiting time for everyone – not just the patients who join shared appointments,” Professor Ramdas adds.

Professor Ramdas is calling for more rigorous and scientific testing of the new approach. The trial she and her research colleagues are running with the Aravind Eye Hospital in India is doing just this – examining the benefits of shared medical appointments, measuring patient knowledge, satisfaction, medication compliance and future appointment attendance.

It’s the sort of investment in radical innovation that will be essential if the UK health service is to deliver on its ambitions to improve healthcare for a growing population over the coming decade.