Care navigators help support patients get to the right service faster

GP practices across Lancashire and South Cumbria are rolling out a new scheme to help support and guide patients to access the most appropriate service for their need.  GPs in Blackburn with Darwen and East Lancashire have been running this service now for nearly a year in Blackburn with Darwen, and nearly two years in East Lancashire.

This scheme in Pennine Lancashire is called care navigation. General practice receptionists and admin staff have been given training to help them direct patients to the right health professional first time.

Dr Kieran Murphy, NHS England (Lancashire and South Cumbria) Medical Director said: “Across Lancashire and South Cumbria we are working hard to make sure that when people need to see a GP, they have access to one quickly and in a way that suits them, be that in person or over the phone.

“We know that sometimes patients find navigating health services difficult and in some cases another health or care professional might be better suited to look after them.  

“Sometimes patients could be seen and treated quicker by a nurse, dentist or a pharmacist for example. That's where care navigation comes in.”

The scheme is designed to help give patients choice, offering them support and guiding them to the right information about other health care professionals who have the expertise to deal with a range of health and care illnesses and injuries.

Care navigation allows front line staff to provide patients with more information about local health and wellbeing services, both within and outside of primary care, in a safe, effective way. It means that patients will find it easier to get a GP appointment when they need one. 

When a patient contacts the practice, the care navigator will ask for a brief outline of the problem, this isn’t about being intrusive, it is aimed to allow the care navigator to identify the patient’s need and provide information about services in the practice, other NHS providers and the wider care and support sector. Where appropriate, they will direct the patient to these services.

Dr Murphy added “The primary goal of care navigation is to ensure that patients get the right care at the right time in the right place with the right treatment or advice.”

If a patient presents with symptoms that would be better dealt with by another service such as a pharmacist or optician, they can be confidently offered these choices, allowing them to go straight to the service which best meets their health and wellbeing needs. Care navigation will support practices and patients to make the best use of valuable NHS resources.

Dr Santosh Davis, a GP at Burnleywood Surgery in Burnley, said: ‘’Care Navigation is making a positive impact at our practice and helping us in part meet the ever-rising demands placed upon General Practice. This has been achieved with an increasing acceptance both amongst our patients being navigated where they are being signposted to the most appropriate service which meets their need. As more services appropriate for Care Navigation are made available then we anticipate this positive impact increasing further.’’   

Case studies from Blackburn with Darwen and East Lancashire

Blackburn with Darwen

In August 2018, Blackburn with Darwen Local Primary Care (LPC) the GP Federation introduced Care Navigation to its 23 GP practices and patients. Care Navigation is a tried and tested model of care that improves access to primary care services for patients and reduces GP pressures all in one. It allows front line staff to provide patients with more information about local health and wellbeing services, both within and outside of primary care, in a safe, effective way. It is about offering patients choice and help to access the most appropriate service first which is not always the GP. It means that patients will find it easier to get a GP appointment when they need one. 

Care navigators are receptionists and admin staff who have been given specialist training to help them direct patients to the right health professional first time. 

For example, when a patient presents with symptoms that would be better dealt with by another service such as a pharmacist or optician, patients can be confidently offered these choices, allowing them to go straight to the service which best meets their health and wellbeing needs. 

Across Blackburn with Darwen, Local Primary Care (LPC) the GP Federation has introduced five services for care navigators to signpost to and more will be added as this develops. 

These are: 

• Minor Eye Treatment Service
• Health and Wellbeing
• Age UK
• Community pharmacy
• Dental

Six months on, and audit of the service has shown that in effect around 500 (3%) of the patients who attended their GP practice for an appointment have been identified as benefiting from other services and signposted quickly and effectively to these other, more relevant services. 

The range of services that patients were signposted to include Age UK, dental, ophthalmology, community pharmacy and health and wellbeing services in Blackburn with Darwen.  The outcome of this is that patients saw a more appropriate service and didn’t use their GP unnecessarily and approximately 500 other patients who really needed to see their GP got see to one quicker due to the appointment being freed up. 

East Lancashire CCG

East Lancashire was one of the first CCGs nationally to introduce Care Navigation and were able to achieve this through working directly with the national Care Navigation Vanguard site based in West Wakefield, Yorkshire.

A total of 53 GP practices are now actively using Care Navigation which initially involved the issue of 390 on-line training licences and 375 staff attending face to face training events that were held across East Lancashire. 

Care Navigation can play a vital role in the signposting of patients to the right services at the right time. In 2018 one of the East Lancashire GP Practices (Rosehill Surgery in central Burnley) was selected to be part national Care Navigation evaluation.

East Lancashire CCG have supported its GP Practices throughout the introduction of this initiative through the development of a more effective method of Care Navigation data collection and specific training aimed at dealing with effective communication and its implications for Care Navigation. 

Using the latest information received from East Lancashire GP Practices (January 2019) approximately 350 patients were navigated to appropriate services in that month.

East Lancashire have linked the referral criteria for all of their services (listed below) to a community supported locality directory of service in each of its five localities (Burnley, Hyndburn, Pendle, Ribble Valley and Rossendale) and the initiative has initially been found to save GP time at scale, whilst also being accepted by patients.

Each of the directories are publically available in addition to being available to the GP Practices and through a template linked to the GP Practice clinical system and patient records. 

So far two phases of services have been introduced:-

Phase one services:-

● Emergency Dental and Dental Practice registration

● Self-Care with your Pharmacy

● Minor Eye Condition

● Talking Therapies 

Phase two service:-

● Age UK Services

● Age UK Hospital Aftercare

● Bereavement Services

● Citizens Advice Service

● Community Connectors

● Ear Syringing

● Lancashire Wellbeing Service

● Low Vision Aids

● Nutrition Support Team

● Substance Misuse – CGL Inspire Service

● Up and active Service 

A third phase is currently being developed and anticipated to include:- 

● Sexual Health Services

● Dementia Connect

● Quit Squad (Stop Smoking Service)

● Carers Link

● Steady On (Falls Service)

● Royal British Legion 

A key message of the training provided to practices is that Care Navigation offers the patient ‘choice not triage’ to access the most appropriate serve first which as we know isn’t always the GP. 

The CCG feels that Care Navigation should not just be for GP Practices but also represents an opportunity for all East Lancashire Primary Care contractors in terms of appropriate signposting.

A process of care navigation combined with a reliable directory of service has allowed reception / care navigation staff the ability to provide patients with more information about local health and wellbeing services both within and outside of primary care in a safe and effective way.