Sharing Evidence Routine for a Patient Centred Plan of Action



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.

Project aim

To improve clinical care of individuals with multimorbidity through development of a person centred evidence informed consultation model.

Project objectives

  • 3 To investigate how trainee GPs can best be trained in and supported to use the SHERPA model.
  • 3 To explore how well trainee GPs implement SHERPA in practice and what factors influence this.
  • 3 To assess the impact of SHERPA on GPs’ practice with patients, and patients’ perception of its usefulness.

Project activity

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.

Anticipated outputs

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

Next steps

  • " The team are currently 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.

Chief Investigator: Dr Edmund Jack

Edmund Jack, General Practitioner and Course Tutor, gives a short example of the kind of questions the Making Sense of Evidence training can help you answer.

This research was supported by the Health Education England (HEE) and National Institute for Health and Care Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.