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Table 7 Details of structure and content of main trial GP training sessions

From: Integrating clinician support with intervention design as part of a programme testing stratified care for musculoskeletal pain in general practice

Timing Topic Detail Methods & Resources
Intervention Practice – 2 h in a single session
 10 Min Introductions ▪ Personal introductions, roles, etc.
▪ Brief outline of the practice and its population
▪ Special interests of GPs
Pre-trial background sheet completed by practice
▪ Informal chat to get people warmed up
 15 Min Brief outline of study, stratified care approach and pilot study results ▪ Background to study
▪ Explain prognostic risk
▪ Clinical conditions and sites involved
▪ Summary of pilot results
▪ Proportion in each risk group
Few slides – scant detail
▪ Interactive
Emphasise “Risk” is of chronicity/complexity not pathology
Explain complementarity with diagnostic process presentation and brief Q/A
 30 Min The STarT MSK tool in practice ▪ Overview of questionnaire and matched treatments
▪ GP actions we hope to foster
▪ Providing the tool score to onward treating clinicians
▪ Trying out the tool – paper exercise:
 ➢ GPs work in pairs, each with a vignette
 ➢ One asks questions and completes paper tool, other responds from vignette
 ➢ Swap roles for second vignette
 ➢ Compare scores and experience of using tool
▪ Use of the tool in consultations - video
▪ Discussion around slides:
Pyramid slide for overview
Questionnaire and matched treatments
▪ Giving patients score and recommended options
Communicating score in referrals
Paper copies of vignettes and risk tool
Live EMIS system with template
▪ Demo of template use
▪ All GPs trying out template, using vignettes, with no attempt at consultation elements
Video of mock TAPS consultation
 30 Min Simulated “consultations” using vignettes ▪ Facilitator gives outline from a TAPS vignette, as a patient might present
▪ GP uses template to get score and treatment options
▪ GP explains and negotiates options
▪ Facilitator might try asking/challenging for other options
▪ Skills session
▪ Emphasise simulation and not role play
▪ Use selection of low/medium/high risk vignettes as basis
Set up clinical computer in a consulting room if possible
▪ GP or facilitator gives outline story
▪ Group works together on suggestions – problem-solving approach
Prompt sheet for consultations
 10 Min GP management of low risk patients ▪ Effective reassurance
▪ GPs’ confidence in managing low risk
▪ Resources available for low risk management
▪ Other primary care team members involved in low risk?
▪ Discussion about how GPs will manage low risk
▪ How to provide effective reassurance
▪ Look at advice materials
Printout of PILS + Leaflets
 20 Min Management of medium and high risk patients ▪ Addition of layers to complement low risk management
▪ Directed at specific pathology and wider issues e.g. co-morbidity, psycho-social, employment, etc
▪ Physio hubs and provision we have negotiated
▪ Detail of physio referral process – how would GPs like us to set it up?
▪ Liaison with physio in high risk patients if needed – Email arrangements
▪ Discussion around recommended treatment options
▪ Emphasise MSK rehab for high risk
▪ Hub physios to attend if possible to build personal relationship and clarify arrangements
Paper copies of matched treatments to illustrate
 5 Min Action plan and lead GP actions ▪ Lead GP role:
 ➢ Keep a training record
 ➢ Cascade training to locums, etc
 ➢ Respond to monthly feedback email
 ➢ Liaise with team over any issues or problems
 ➢ Dealing with queries
▪ Additional support if needed
▪ Who to contact etc
Training record for practice
Sample monthly feedback report
Prompt sheet for GPs
Training session for control practices – 1 h or less
 10 Min Introductions ▪ Personal introductions, roles, etc.
▪ Brief outline of the practice and its population
▪ Special interests of GPs
Pre-trial background sheet completed by practice
▪ Informal chat to get people warmed up
 10 Min Brief outline of study its background and scope ▪ Clinical conditions and sites involved
▪ What we are investigating, in general terms
▪ Questionnaires to patients
▪ Medical record review
Few slides – scant detail
▪ Interactive presentation and brief Q/A
 10 Min What we ask of GPs ▪ Patient verbal consent for study and record of this
▪ Pain score and pain site recorded in >50%
▪ Usual care of patients
One slide
 15 Min EMIS template ▪ Demonstration of real template and practice with it  
 5 Min Additional support ▪ Coping with GPs absent from training or joining later Briefing session by Practice Manager Laminated prompt sheets for all GPs