SHERPA

What is SHERPA?

This project aims to offer a structured approach for GP trainees to manage consultations with their patients who have multiple health conditions for which no single set of guidelines will cover.

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.

The aim of the project is to improve clinical care of individuals with multimorbidity through development of a person centred evidence informed consultation model.

Objectives

• 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 will initially develop the 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 will be tested more widely with healthcare staff who would make up the multi-disciplinary team that supports patients with multiple health conditions.

Once the teaching structure is refined, the team will assess to what degree the SHERPA model can be helpful in structuring patient consultations and how GPs engage with the training material. We will define the components of the SHERPA model that are important in influencing practice through feedback from the GPs using the model.

Finally, our findings will be analysed and published towards the end of 2018.

The SHERPA model detail and evaluation will be published in late 2018. If found to be useful the training will be incorporated into routine professional training for GPs in the region. We plan wider implementation to follow.

We plan to look further into the effectiveness of the SHERPA model in a general practice setting with multi-disciplinary teams and, in turn, the impact adoption of the model in this setting may have on patient outcomes and satisfaction with care.

The team are current refining the SHERPA model and teaching material using an initial participant feedback cycle. A full training and evaluation cycle is due to commence in the autumn of 2018.

SHERPA – a new model for decision making with patients with multi-morbidity

The SHERPA model, (Sharing Evidence Routine for a Person-centred plan of Action) was developed as a practical framework to help clinicians as they work with patients with multimorbidity. It provides a new three-step method for evidence informed and interpretative decision making. It is particularly focused on those with multimorbidity as their needs are not well met by current guidelines; consultation models or indeed the health system as a whole. This is because guidelines address single conditions; consultation models focus on an individual problem and the system is fragmented. The SHERPA model aims to give clinicians the tools to work in a different way.

The workshop set out to: describe the SHERPA model and its 3 step approach; apply this to some example cases and consider how it could work for their practice. In so doing help us to refine and develop the model. We were fortunate to be joined by a group including General Practitioners (GPs), an experienced primary care and student nurse and a commissioning manager.

The discussion around the model and case work was really valuable. We drew on the groups diverse perspectives and experience. Elements of the model that were well received were its practical approach to a complex problem and the emphasis on developing a broader bio-psycho-social approach. Drawing out the model and eliciting the causal links that exist was valuable in allowing a shared understanding and making this overt for both clinician and practitioner. Comments were made that this diagram could help inform multidisciplinary work in terms of which members of the team could help the patient and how. 

There was a discussion about how to best to involve patients with the process. Understandable concerns were raised about how to fit the model into the current 10-minute consultation and ensuring it integrated with relevant software. Ideas of turning the model into practice by using software/smart whiteboards were suggested and that using videos and actors could help demonstrate how the model could be drawn out in real time.