Assemble your team
A well-prepared and enthusiastic team is a must to successfully establish and coordinate a programme of Shared Medical Appointments. Here's a list of the key roles you'll need to fill.
Nominate a champion to oversee the practice processes, implementation and ongoing management of the SMA.
The SMA programme in a practice needs to be supported by a practice champion and coordinator to
- Keep the momentum
- Reduce the administrative burden on the practice
- Embed SMAs as routine practice activity
The facilitator can be a doctor, nurse, MCA or allied health worker and is key to the success of the SMA. The facilitator needs to:
- Have the skills to facilitate a group of diverse individuals,
- Maintain time and keep people focused,
- Elicit good discussion,
- Manage members of the health care team and
- Deliver the outcomes sought by the patient and the clinician.
The facilitator is the person charged with keeping the group guidelines at the forefront of the SMA and ensuring the SMA is meaningful to all members of the group.
The facilitator needs to have an understanding of the group’s physical needs, medications, disease progression, support structures, care plan, health goals and alternative treatment/care options available in the community.
The facilitator uses their skills to build on discussion, make sure patients understand not only the process of the SMA but the discussion. The facilitator is pivotal to improving a patient’s level of health literacy.
The clinician has the one-on-one medical consultation with the patient to answer the question/s the patient came to the appointment with, discuss medications and general health and well-being.
The clinician ensures the patient they are consulting with feels listened to by maintaining a focus on that patient alone.
Should a patient require a physical examination, the clinician can decide if this occurs before, during or after the SMA. Understanding the needs of the group of patients will help the clinician determine when the examination should occur so it doesn’t disrupt the group too much.
If the facilitator or recorder of the SMA is a clinician they may have input into the consultations as part of the team approach to patient care, but only during discussion, not the ‘formal’ consultation.
The clinician can also order tests, vaccinations, procedures and appointments with the extended care team to occur after the SMA or at another time. These can be organised by the facilitator as the SMA is continuing.
The recorder of the SMA needs to be able to understand what is being said during the consultations and record the outcomes and recommendations accurately in each individual patient’s notes.
What is recorded should also be reflected in the patient’s health plan and any self-management documentation, handouts they take away from the SMA.
If the person recording individual consultations in the SMA is not clinical then we would recommend the following points are included as part of the patient consent process.
The patient is aware that a non-clinical person is attending the SMA and has signed patient confidentiality as part of the practice quality standards
- The person recording in the patient notes is not a clinician but has access to the patient’s notes for the purpose of the SMA.
- The patient’s notes system identifies who is writing into the patient’s notes. This is linked to the audit process of the practice.
- All notes are agreed/signed off as part of the team debrief