[DAYS_LEFT] days left of your Medeconomics free trial

Subscribe now

Your free trial has expired

Subscribe now to access Medeconomics

How 'active signposting' can benefit practices

Active signposting is one of the 10 high impact actions that practices can take to free up GP time, according to NHS England. But what does it mean in practice? Rima Evans reports.

Enhancing a receptionist’s ‘customer service’ role in GP practices is a key plank of NHS England’s strategy to expand workforce capacity and help alleviate pressures on primary care workload.

A pot of £45 million was announced in last year’s GP Forward View for training practice administration staff and receptionists. While £5 million was available for 2016/17, £10 million will be available in each of the next four years.

The funding for training clerical staff is to provide them with the skills to deal with clinical correspondence within the practice. So what is in mind for receptionists?

To be eligible for a slice of the funding, being held at CCG level, it should be used to enhance their customer care skills so they can offer ‘active signposting’ for patients.

NHS England describes this ‘providing patients with a first point of contact which directs them to the most appropriate source of help’, which is not always the GP.

‘Receptionists acting as care navigators can ensure the patient is booked with the right person first time,’ it adds. ‘It requires the receptionist to be skilled and confident in sensitively ascertaining the nature of the patient’s need and exploring with them safe and appropriate options.’ These might include sources of advice and help from within or outside of the surgery.

The aim is to free up GP time and improve the patient experience by ensuring they go to the service that best meet their health needs faster.

How it works

In Wakefield, West Yorkshire, 277 receptionists have now been trained to ‘care navigate’.

It is one of the first areas to move to this model of working, building on an initial pilot started by a group of six practices in west Wakefield in 2014 under the GP federation they created called West Wakefield Health and Wellbeing Ltd.

David Cowan, care navigation programme manager at West Wakefield Health and Wellbeing, explains that the service is about widening access and choice for patients, giving them more information to help them get to the most appropriate professional.

A patient will still always be offered the option of seeing their GP, he adds. But now the general practice frontline staff will highlight an alternative healthcare professional or service they could access that could be more appropriate.

This could be a choice of practice or specialist nurse, pharmacist, physiotherapist, or services such as 111 (to access an emergency dentist), social services, mental health support, minor ailments, community acute ophthalmology, contraception and sexual health, smoking cessation, a wide range of community support and voluntary services for carers, the elderly and more.

However, for the service to work, it is essential care navigators properly ascertain that they are signposting to an appropriate service.

Mr Cowan says: ‘When a patient rings up for an appointment the member of staff will ask a bit more about the nature of the problem. For each service, we have developed simple inclusion criteria and exclusion criteria, which staff will be trained on, so they can direct patients to services in a safe and effective way.’

He stresses that frontline staff are not carrying out clinical triage or required to ask complex questions. ‘They need to ask some basic questions about a patient and their general health so they can identify whether that person is eligible for a service. It would undermine the system if patients were sent to a service they later discovered they couldn’t access because, say, they were pregnant or not the right age.’

Educating patients

Mr Cowan adds: ‘We are not choosing for patients. It’s more about educating patients about other services available. Patients would always be told to come back should the problem not be addressed or treated.'

West Wakefield Health and Wellbeing has become one of the lead providers of care navigation training. Under its training programme the active signposting service is phased in, starting small then scaling up as staff and patients gain trust and confidence.

Initially, the programme focuses on developing the access criteria to enable active signposting to a handful of core services, and is then widened out to other services at a later stage. This is followed by accredited training for frontline staff.

The various services involved are invited to attend workshops so staff can gain a better understanding of what they do and how they work. Training up the wider practice team is beneficial, explains Mr Cowan.

‘Peer-to-peer support is a key factor for success of the care navigation programme,’ he says.
Patients were cautious about using the service at first, Mr Cowan admits. But as it has expanded it has brought about a real shift in behaviour.

Does it make a difference?

Data from an independent survey carried out in 2016/17 covering 18 practices showed that 92% of all signposts were accepted by patients. Moreover, 97% were happy to see the healthcare professional they were signposted to. A total of 81.5% of patients felt it appropriate for receptionists to care navigate.

Calculations based on a single Wakefield practice with seven whole-time equivalent GPs and a 12,500-patient list size show that 976 GP hours (measured by face-to-face consultation time) have also been saved during 2016/17. ‘Feedback from staff shows higher job satisfaction since they are directly helping patients,’ Mr Cowan adds.

Another key benefit is that it is a sustainable and lower cost model because it is promoting better use of health resources, other than the GP.

Read more

Medico-legal advice on what to consider when upskilling practice staff

Have you registered with us yet?

Register now to enjoy more articles
and free email bulletins.

Sign up now
Already registered?
Sign in

Would you like to post a comment?

Please Sign in or register.