Conexus Healthcare provide Care Navigation consultancy & training to CCGs and GP Federations across the United Kingdom. As the population ages and prognoses for many previously life threatening and limiting conditions improves, the UK is facing a significant sustainability challenge in being able to adequately resource medical and social care.
Within the GP Forward View, NHS England identified ten high impact actions GP practices could take to use their resources more efficiently and release time for care, including Care Navigation. Care Navigation, pioneered by West Wakefield in 2014, is a model of care which helps patients access a wide range of Health and Social Care services and Health professionals, through General practice reception signposting. Care Navigation often directs patients to services that they were unaware of, and helps them get the support and care they need faster, without having to wait for a GP appointment.
This helps to get patients to the right place, at the right time, and releases capacity for patients that need to see a GP. Conexus have now developed an accredited consultancy & training programme, based upon the learning from the West Wakefield pilot, which has been spread to practices covering 15% of the English population.
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 practice reception and wider teams. 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. 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. In addition, there was an increasing amount of evidence emerging from the UK and overseas, particularly from Canada, to support the theory that care navigation will help enhance patient and carers’ experience, and promote self-care.
Through the development of the model in Wakefield, over 20 services or alternative health professionals were identified, and pathways developed for each of these. West Wakefield hosted a great quantity of training events, to either introduce receptionists into this way of working, or increase the ability and confidence of current care navigators.
By March 2017, West Wakefield had trained over 270 care navigators across the entire district. During 16/17, 25,852 Wakefield patients were offered choices of services or booked appointments with more appropriate sources of care, and other clinicians working in the practices. Furthermore, of the patients that were surveyed, 97% were happy to see the healthcare professional they were signposted.
Since the start of 2017 Conexus Healthcare has now introducing Care Navigation the ‘West Wakefield way’ across more than 900 practices in England and Wales, a number which continues to grow. 4831 learners across the country have now completed the online accredited learning course, with many more attending the face to face learning events that West Wakefield facilitates. The platform has been highly praised by learners, and 96.4% of learners understood how to care navigate a patient following the training.
Conexus Healthcare is now replicating its success across the country, and is working in over 40 CCGs / GP Federations covering 15% of the England patient population, numbers which continue to grow. 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. The first CCG that the model spread to was South Tees CCG who went live summer 2017. In South Tees CCG, 22 practices received the training and went forwards to use the data collection template.
In the first four months 12,127 patients were signposted, with only 4% declining the navigations. 27% of those signposts were to the practice nurse, thus utilising resources more appropriately, 48% were to a recently established GP extended hours hub. Also, the signposting included Improving Access to Psychological Therapies (IAPT) which has meant that more patients were able to access mental health support without the need to see a GP first.
During 2016/17, 25,852 Wakefield patients were offered choices of services or booked appointments with more appropriate sources of care, and other clinicians working in the practices. 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. Areas where we have spread our learning to have also seen impressive results, some examples are:
• 35 practices in North Staffordshire & Stoke on Trent had signposted 11,939 patients in 6 months.
• 22 practices in South Tees had signposted 12,127 patients in 4 months
• 19 practices in Hereford had signposted 11,140 patients in 5 months.
All of these practices are getting patients to the right place, at the right time through care navigation, and are freeing up thousands of hours of GP time, which can be used to benefit a growing number of patients with long term complex conditions.
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. This involved:
• 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. As part of the work to replicate the model across the country, Conexus bring the CCG together with local GPs, Practice managers, receptionists, providers of services, public health, patient panels and business intelligence. This collaboration results in a local model of Care Navigation that works for the practices in the district. The receptionists are then introduced to the concept and have an opportunity to engage and learn from the providers of services.