Patients with multimorbidity have poor health outcomes, high burden of care and can feel bewildered by their conditions, medications and the healthcare system. Managing patients with multimorbidity is a vital general practice role, yet GPs identify this as a deficit in their training.
There is currently no standardised approach for practicing or teaching clinical decision making around multimorbidity. NICE Guidelines on multimorbidity (2016) highlight objectives for managing patients, but offer little guidance about how to make decisions. We developed the SHERPA model (Sharing Evidence Routine for a Patient Centred Plan of Action) to address this gap.
Following Sackett’s Evidence Based Medicine Model, the principle of SHERPA is to structure the consultation so that the clinician can confidently tailor appropriate evidence-based guidelines, which tend to concern single health problems, to their individual patients’ health priorities and preferences, bearing in mind that by definition the patients concerned have multiple health problems.
To improve clinical care of individuals with multimorbidity through development of a person centred evidence informed consultation model.
- To investigate how trainee GPs can best be trained in and supported to use the SHERPA model.
- To explore how well trainee GPs implement SHERPA in practice and what factors influence this.
To assess the impact of SHERPA on GPs’ practice with patients, and patients’ perception of its usefulness.
The team have developed teaching materials required for trainee GPs to learn the skills to structure consultations using the SHERPA model with their patients who have multiple health conditions. These teaching materials are being tested more widely with healthcare staff who would make up the multi-disciplinary team that supports patients with multiple health conditions.
The team have been assessing to what degree the SHERPA model can be helpful in structuring patient consultations and how GPs engage with the training material. We will continue to develop the components of the SHERPA model that are important in influencing practice through feedback from the GPs using the model.
The SHERPA model intial evaluation with trainee GPs has been published. Training is now being incorporated into undergraduate teaching and some routine professional training in the region. We plan wider implementation to follow.
The team have completed a full training and evaluation cycle with trainee GPs. Further developments in theory and practice are underway.