Intended for healthcare professionals


Shared medical appointments

BMJ 2017; 358 doi: (Published 30 August 2017) Cite this as: BMJ 2017;358:j4034

Chinese translation


  1. Benedict Hayhoe,
  2. Anju Verma,
  3. Sonia Kumar
  1. Department of Primary Care and Public Health, School of Public Health, Imperial College London, UK
  1. b.hayhoe{at}

A promising response to escalating demand for healthcare

Demand for healthcare is escalating, owing to ageing populations and increasing case complexity. Healthcare systems globally are facing unprecedented and rising deficits, with the prospect of punishing cuts to essential services. Consequently, new models for providing safe and effective care for patients while reducing healthcare costs are urgently sought. One such innovation is the shared medical appointment (SMA).

Shared medical appointments

First proposed by Noffsinger,1 shared medical appointments were conceived as a clinical encounter in which patients receive healthcare, from one or more health professionals, in a group setting. This includes patient education and counselling, physical examination, and clinical support. Patients attending shared appointments usually share a key attribute, such as medical condition.

Sharing elements with traditional patient education groups, shared appointments uniquely incorporate clinical interventions, such as history taking, examination, and clinical management. During appointments of about 90 minutes, up to 12 patients can share experiences, interact with facilitating professionals as a group, and receive one to one care. Variations on this model have the clinical component delivered in a group setting, with patients able to listen and contribute to other consultations, or as private one to one consultations held in parallel with group work. Patients newly diagnosed with diabetes, for example, may receive interactive education on the condition and treatment options as a group, accompanied by one to one sessions with a doctor for examination and personalised management, returning to the group to discuss lifestyle. In this way shared appointments combine two effective models, group peer support and clinical one to one care, while substantially reducing clinical time commitment.

How and where do shared appointments work?

Kirsh et al proposed several causal mechanisms for the beneficial effects of shared appointments.2 The group setting promotes self management through learning from others’ experiences2; it allows more equitable relationships to develop between patients and professionals, engendering greater trust, while enabling professionals to learn from patients how best to support their needs. Patients and professionals gain from having more time in the consultation. Interestingly, these mechanisms map closely to the theorised “curative factors” of group psychotherapy that inspired shared medical appointments.3

Investigating the effectiveness of shared appointments is not without methodological challenges, but the body of research into their use is growing. The strongest clinical evidence is in diabetes, where shared appointments result in demonstrable improvements in HbA1c and blood pressure.4 Studies have, however, successfully used SMAs in many other conditions and settings, in primary and secondary care, including care for cancer survivors,5 high use of medical care,4 pain management,6 substance misuse,7 health screening for elderly people,8 and chronic heart disease.3 Technology, including video conferencing, has also been used to provide SMAs for patients living in rural areas or those with mobility difficulties.9

Researchers have considered a range of patient related outcomes of SMAs, suggesting that they can facilitate effective information giving, improving patients’ knowledge about their condition and its management,35 and leading to more effective self care.10 Patients participating in SMAs report fewer symptoms10 and express greater satisfaction with and perceived access to care311; quality of care and quality of life are also more highly rated in SMAs.10

Shared appointments in practice

Healthcare system outcomes were central to Noffsinger’s original proposal, and subsequent studies have supported the ability of shared medical appointments to improve access to care,3 while reducing the use of routine as well as emergency healthcare.34 However, evidence of impact on overall healthcare expenditure is conflicting, with both higher and lower costs resulting from introduction of SMAs in different studies,4 and widespread adoption is likely to prove costly, at least initially, in terms of development and implementation.5

Most literature focuses on the advantages of shared appointments, but challenges clearly exist in this new mode of consulting. Chief among these is likely to be the issue of confidentiality3: patients will be comfortable to varying degrees with sharing medical information in a group setting, while professionals fearful of breaches of confidentiality will need to develop skilful approaches to the management of such information sharing.

In addition, the established model of doctor-patient consultation is deeply ingrained: both professionals and patients may be reluctant to engage with shared appointments, and just as they will not be appropriate for all conditions or settings, they will not be for everyone. Nevertheless, it seems clear that they can be delivered successfully, and efforts are already being made to support training and implementation needs for their use in primary care.12

Although the overall number of studies remains small, and the strength of evidence is marred by heterogeneity of studies and settings, the evidence base for shared medical appointments is growing, and facilitated peer interaction alongside traditional individualised management has the potential to add value for patients and healthcare professionals. Further research is needed to define the most effective model of SMAs—and how and where they may be most usefully implemented in practice—and to evaluate their effectiveness in improving quality of care and reducing healthcare costs.


  • Funding: This article was supported by the Imperial NIHR Biomedical Research Centre and the NIHR CLAHRC for NW London. The views expressed are those of the authors and not those of the NIHR.

  • Contributors: BH is clinical lecturer in primary care in the Department of Primary Care and Public Health, Imperial College London, and is funded by the National Institute for Health Research (NIHR). AV is primary care faculty development lead in the Department of Primary Care and Public Health, Imperial College London. SK is director of undergraduate education in the Department of Primary Care and Public Health, Imperial College London. All authors worked to shape the article and contributed to the text of the manuscript. BH brought all contributions together in the final draft. All authors approved the final manuscript.

  • Competing interests: We have read and understood BMJ’s policy on declaration of interests and declare the following interests: BH, AV, and SK are GPs working in the NHS.


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