Why do GP Practices & PCNs need Care Navigation?

Care navigation is a person-centred approach that uses information and signposting to help primary care patients, and their carers, access the most appropriate healthcare professional as soon as possible. Often, patients do not need to see a GP first as there are many services that they may be able to access through self-referral, if they only knew about them.

Why do we need Care Navigation?

GP Online reported in 2019 that over the four years to September 2019, the full-time equivalent (FTE) GP workforce grew by 1.3%. However, they go on to say that this figure includes registrars, and rising numbers of GP trainees over the period conceals a 3.7% drop in fully qualified GPs.

There is an increasing number of patients to treat with the population of the UK estimated at 66 million mid-2017, its largest ever. The projected population surpasses 70 million in 2029 (ONS 2017).

Through the NHS Long Term Plan (2019), there is funding available to employ a widening workforce of allied healthcare professionals for practices who work together in Primary Care Networks (PCN), covering 30,000 to 50,000 patient populations.

NHS Digital reported that ‘there were 5,027 more qualified allied health professionals (FTE) in March 2017 compared to March 2010 an 8.51% increase.’

Care navigators can help play a role in supporting patients to directly access a wider health and social care team available in PCNs.

Encouraging patients to use Care Navigation

Patients often believe that the first best person to see is a GP, but perhaps “asking your GP practice receptionists who is the best person to help you with that problem” could increase the options available to patients.

GP phone messages have been used to explain the care navigation service before the patients speaks with the receptionist. GP phone messages include:
“Hello my name is Dr ….. and I am the senior partner. If you have chest pain please hang up and re dial 999 immediately. Alternatively, you will shortly be put through to the reception staff. We have asked the receptionist to ask you if you wouldn’t mind telling them a little about the problem you are calling about today. This is simply so they can direct you to the person who would be most suitable to help you with your problem. Of course, you don’t have to do this, but it would help us to help you and other patients. Thank you very much”.

Accessing services through Care Navigation

Conexus Healthcare’s Care Navigation training helps to provide patients with information. We do not recommend action, but the information helps the patient choose the best service for their needs.

Patients always have choices based on locally agreed pathways and if they ask for a clinician’s appointment they can of course still see one, if an appointment is available.

Service access criteria is developed locally and with consensus of your key stakeholders such as your practice staff, service providers, commissioners, patient representatives and GPs. Conexus Healthcare’s workshops help you to do this.

The service criteria is often reviewed by clinicians in the workshops before being included in the local care navigation information. Doing it this way also ensures that your care navigation service doesn’t offer services incorrectly to patients who aren’t eligible. For example, under 16’s or over 60’s would not be offered the choice of attending ‘Pharmacy First’ for thrush symptoms.

The General Medical Council (2020) states that calls may be recorded for legitimate reasons and that practices should inform patients that they are recording calls. We also recommend, among other things during the endorsed online training, that patients be reassured:

“If your condition worsens, please come back to us.”
“If this service we have provided you information on, does not meet your needs, please come back to us.”

Working with service providers is a two-way-street

In some instances, patients who have been care navigated may need to be put back in touch with their GP practice. For example, a patient may have been signposted to a pharmacist and when the pharmacist undertakes a clinical triage for the symptoms, they identify a red flag where the patient needs to be seen by a GP.

Pharmacists report using RAG systems for patients who need to contact their GP practice:
Forms that are green indicate a patient needs to be seen within two weeks
Forms that are amber indicate a patient should be seen within the next few days
Forms that are red mean a patient should be seen urgently.

In other cases, practices provide their local pharmacies ‘by-pass numbers’ so that patients who need to be seen, can be directly handed back to the practice without delay.

Pharmacists have confidence to use this system when the practice agrees the purpose for using the by-pass numbers. This can save pharmacists valuable time. It also builds confidence from the pharmacist’s perspective and increases collaboration.

A quote from Kings Medical Practice, through independent evaluation of the care navigation service 2018 in South Tees, found that;

“The chemist was excellent.
I did not realise that they did so many things. The chemist said he would phone my doctor if he needed to. That made me feel better. I did not know they would work together. I am pleased my surgery does care navigation.”

Conexus Healthcare’s Care Navigation consultancy and training ensures that providers of services that will receive signposts are involved from the outset.

This ensures that a common purpose is developed based on what the provider can and cannot help with. It not only increases the likelihood of a successful navigation but ensures safety netting is considered for each service.

Furthermore, the Conexus Healthcare approach can be used to communicate with patients the variety of different services available through Primary Care Networks.

References

Office for National Statistics (2018) Overview of the Population. November 2018. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/november2018
General Medical Council (2020) Recording Telephone Calls. Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/making-and-using-visual-and-audio-recordings-of-patients/recording-telephone-calls
GP Online (2019) GP barometer: Nice charts that show the state of general practice at the start of 2020. Available from: https://www.gponline.com/gp-barometer-nine-charts-show-state-general-practice-start-2020/article/1669063
NHS Confederation (2017) NHS Statistics, facts and figures. Available from: https://www.nhsconfed.org/resources/key-statistics-on-the-nhs
NHS Long Term Plan (2019) Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf

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