The care navigators reducing pressure on GPs

Care navigators have been seen as the way ahead in primary care – reducing pressure on GPs by pointing people to more appropriate services and making them aware of other pathways. But the challenge is how to provide care navigation within the existing resources available in a surgery.

The solution adopted in many areas has been to train practice receptionists to provide this additional signposting service. Receptionists can then direct suitable patients to a range of health and social care services, and alternative healthcare professionals.

As well as reducing pressure on GPs, this can ensure patients get quicker access to the right care including services they may have been unaware of.

Care navigation was pioneered in the West Wakefield area in 2014, with funds from the Prime Minister’s Challenge Fund.

The challenge is how to provide care navigation within the existing resources available in a surgery. The solution… has been to train practice receptionists to provide this additional signposting service

Conexus Healthcare – a GP federation in the area – was central to the programme and has now developed an accredited consultancy and training programme based on that experience. This has now been adopted by practices covering 15 per cent of English patients.

The West Wakefield model started by identifying over 20 services or healthcare professionals which could be an alternative to the patient seeing their own GP. Pathways were developed for how patients could access each of these.

Then receptionists and existing care navigators were trained – over 270 underwent this training by March 2017. In 2016-17, more than 25,000 patients were offered alternatives or booked appointments with more appropriate services or other clinicians, including some working within practices.

Benefits of care navigation

Patients were generally pleased with the service with 97 per cent saying they were happy to see the suggested healthcare professional. “Selling” a new service like this to the public can be a challenge but practices ran short videos in their waiting rooms and used telephone messages to explain the system.

In terms of GP time saved, one practice with 12,500 patients saw nearly 6,000 sign postings in a year – equivalent to 743 hours of GP time being saved. This frees up GPs to deal with patients with more complex conditions who require more input. The results in other clinical commissioning groups which have adopted the scheme have been similar.

With NHS England flagging up care navigation in the GP Forward View, there was significant interest in the rest of the country in how this approach could be adopted.

Conexus has now worked with more than 900 practices across England, with nearly 5,000 people being trained on the online learning course and many others attending face-to-face events.  

“The training has been standardised and formalised and… is responsive to the local area and local population/patient needs”

The model developed in each locality is tailored to what services are available locally and agreed criteria for when receptionists should offer alternatives. Face-to-face training covers what access criteria exist for local services and how to efficiently provide patients with information.

South Tees CCG was the first area to adopt the model outside Wakefield. Twenty-two practices were involved and in the first four months 12,127 patients were signposted to other services.

Around a quarter were signposted to a practice nurse and nearly half were directed to a newly-established GP extended hours hub.

Other services which were prominent included access to psychological therapies, allowing patients to get mental health support without having to access a GP first.

Russell Houghton, performance and improvement manager for Conexus, says that spread of the model has been rapid. “The HSJ award has been absolutely fantastic in promoting the West Wakefield Way,” he says. “We have been able to use the profile that the HSJ award has given us to network better with other areas.”

Bespoke training

The training package has developed based on the intelligence and learning from the first project but is bespoke to each situation, he says. It’s also important to engage with the GP community before the training to understand any constraints and concerns they may have.

“We have to have this relationship – we have to enable and support to overcome that resistance,” says Antony Nelson, managing director of Conexus. “It is about spreading patient choice and by doing so impacting on the practice.”

Practices which had originally been reluctant have been brought on board after news of its success spread – one which had not wanted to join had seen 22 people signposted to other services in the first morning of using the system.  

The judges were enthusiastic about the scheme, praising its “really impressive” spread. “The training has been standardised and formalised and there has been significant learning and development of the training following this – and the training is responsive to the local area and local population/patient needs,” they said.

“This is an excellent way of meeting patient need locally and having a focus on the receptionist and their training. They have maintained a focus on quality and outcomes. There is a good ‘safety net’ for all patients seen by care navigators.”

For more information on Conexus Healthcare’s winning entry visit HSJ Solutions

The 2019 HSJ Awards are now open for entries. For more information on the Community or Primary Care Service Redesign Category visit https://awards.hsj.co.uk/categories