What is the effectiveness and safety of an extended-role GP "Symptoms Clinic"? Results of Multiple Symptoms Study 3

Problem

Persistent physical symptoms occur in all areas of healthcare. They are present in up to 40% of GP consultations and account for at least one third of specialist referrals. Approximately 2% of the population have multiple or recurrent physical symptoms which are disproportionate to currently evidenced pathology. Historically persistent physical symptoms have been regarded as psychogenic or as "medically unexplained". Current evidence suggests that persistent physical symptoms can be explained in ways which patients find helpful and lead to self-management. We aimed to test the effectiveness of an extended role GP “Symptoms Clinic” for patients with multiple persistent physical symptoms.

Approach

Multiple Symptoms Study 3 is a large multicentre RCT conducted in 4 regions of the UK. Participants were individually randomised to either an extended-role GP “Symptoms Clinic” or usual care. The Symptoms Clinic intervention comprised 4 consultations, one of 50 minutes and three of 20 minutes at approximately 2-week intervals. The intervention drew on expert generalist skills and was delivered by 6 extended-role GPs who had received 10 sessions of additional training. The treatment model was manualised but designed to be delivered flexibly. It had four core components: Recognition, Explanation, Action, and Learning. Participants had multiple symptoms and ongoing healthcare use with eligibility based on electronic record search and PHQ-15 symptoms score between 10 and 20.The primary outcome is the PHQ-15 at 12 months after randomisation. Additional outcomes include PHQ-15 at 3 and 6 months and healthcare use in both primary and secondary care.

Findings

Enrolment was between November 2018 and December 2021 with follow-up completed in January 2023. The trial was paused for 6 months in 2020 then switched to online delivery due to Covid-19. Participants were recruited from 108 GP practices in Yorkshire, Gateshead, Greater Manchester and North West London: 37% of practices were in the highest quintile of socioeconomic deprivation. 354 patients were randomised and data for the primary outcome was available from 276 (78%). Process evaluation indicated that the intervention was delivered as intended and qualitative analysis of a sample of consultations and patient interviews shortly after the intervention indicated generally high satisfaction with the intervention and meaningful changes for some individuals.Statistical analysis is now underway. We expect to present data relating to the primary outcome results at the conference.

Consequences

If MSS3 is shown to be safe and effective, either in improving symptoms or reducing subsequent healthcare use without worsening symptoms, then it provides a model for enhanced generalist care of an important group of patients who currently use substantial healthcare resources with little benefit