* Please describe the challenges or problems your solution set out to solve.
When patients have health problems, commonly the first person they think about contacting is their GP. However, the GP is not always the best person to see. Patients can be offered choice through developing the practice team. Initially, there were concerns about receptionists offering patients inappropriate choices or making clinical decisions.
However, with locally designed pathways to provide patients with right choices when they contact general practice, clinicians and receptionists were given confidence, in that care navigation is a safe and effective way of working. A process of developing pathways for local services and clinical sign off was required.
* Please describe the actions you took to achieve your result.
Frontline staff can play a pivotal role in general practice. The Care Navigator role was to support patients with good choices and relieve pressure on GPs. Taking inspiration from a care navigation scheme in the US, the idea was formed that receptionists and other frontline staff could be provided with specialist knowledge about the alternative healthcare professionals and services in their area.
West Wakefield established a working group of practice managers, receptionists, third sector, patient representatives, and Public Health carefully designed an outline of a care navigator role and together developed a robust directory of local services that care navigators could quickly and easily access. Access criteria had clinical oversight from GPs within West Wakefield, ensuring the choices patients were presented with, were safe and effective.
As a result, GP’s time could be released to spend more time with people with long term conditions, more complex needs. West Wakefield worked collaboratively with the wider Wakefield system to understand what services would work for the area, as well as providing a safe environment for the Practice staff to navigate within.
• Identifying the local services that patients can access
• Identify access criteria and red flags for each service
• Prioritise the services in roll out
West Wakefield have used simple and easy ways to explain the new system to patients. For example, displaying posters with a likeness of their own GP, running short videos in GP waiting rooms, and getting GPs to record short telephone messages, explaining the care navigation process and encouraging patients to talk to receptionists.
Receptionists themselves also find additional job satisfaction in this expanded role, particularly where it is newer to them and they have confidence in their awareness of the options available. A typical comment has been: “I feel a great sense of satisfaction when I have directed someone … We are saving GP appointments.
The patients benefit. Patients ring up and say thank you…its things like that. I am loving it. That little bit made a difference”. At one practice in West Wakefield of 12,500 patients 5819 sign posts were achieved in 2016/17 which equated to 743 GP hours. Our Platinum consultancy and training programme cost of £25,000 was applied to our six practices to provide a working example, with the cost of physio first and pharmacist in practice £64,000 ROI was achieved. Where we have implemented care navigation externally, similar results have been achieved.
* Please list the most significant results
• In 2016/17 25,852 patients were signposted
• 97% of patients that were surveyed were happy to see the healthcare professional they were signposted to.
• Below 5% of patients that were seen by their community pharmacy were sent back to their GP and none were ‘urgent’.
• Trained 277 care navigators in Wakefield
• Spreading to over 2700 receptionists, plus 1500 signed up covering over 10% of the patient population in England
• 98% of learners understood how to care navigate a patient
• Winner of the General Practice Awards 2017 – ‘General Practice Forward View Innovations – Developing the Practice Team’
* Describe how your project has spread to other teams, departments or organisations
West Wakefield is now replicating its success across the country, and is working in a growing number of CCGs/ GP Federations covering over 10% of the England patient population. West Wakefield has developed an accredited training and consultancy programme. We co-develop a local model of care navigation, prioritising services and agreeing criteria in which receptionists should offer choice. Receptionists access online accredited training modules.
In line with Health Education England Competency Framework 2016, Care Navigators are taught about the access criteria for local services in face to face learning events, as well as how to efficiently provide patients with information.