Note: Some sections of this case study refer to clinical commissioning groups (CCGs). On 1st July 2022, integrated care systems (ICSs) took over statutory commissioning responsibilities in England, and CCGs were closed down. You can learn more about integrated care systems (ICSs) here.
Case study summary
The Deben Health Group in the East was looking to implement care navigators to direct patients more effectively to the most appropriate person for their needs, helping to free up time for GPs to see those patients who need their care the most. The CCG supported practices in the group to do this work through the Learning in Action element of the Time for Care programme. The programme is part of the support available through the General Practice Forward View.
Use Learning in Action to develop a care navigation protocol and resources, to enable reception teams to effectively navigate care across all eight practices in a consistent way.
Working collaboratively across eight practices
Four Learning in Action workshops were held over five months, where a group of receptionist representatives from each practice came together. It was the first time receptionists in the patch had the opportunity to meet each other, network and share ideas.
Using quality improvement tools and techniques introduced during the workshops, the group set about creating and testing protocols that would launch and embed the role of care navigators. Sessions at the workshops focussed on working collectively on different elements of the project, such as developing a protocol, looking at privacy and safety issues. Actions were then shared out amongst the group to take away to test and work on further back in their practice. Progress was shared at subsequent sessions, feeding back what worked well and where any issues arose that the rest of the group could help with e.g. creating new urgent and emergency appointment templates, privacy slips for patients and new phone messages.
Working collaboratively the group achieved the following:
- Process mapped the steps currently taken to signpost patients, which showed there were far too many steps and people involved. For example, the group found that if practices changed the way they asked patients for their information at the beginning of a call, it could significantly reduce the number of steps in the process. Following the exercise a new process was designed which was more streamlined and efficient, removing the steps that added no value.
- An outcome of the process mapping was to create a unified protocol across the practices. This outlined what care navigators should see as urgent and not so urgent, which service and/or clinician was best to direct patients depending on their needs etc. A3 mats were produced to be placed alongside every receptionist’s computer, listing contact details for all the different organisations that patients could be referred to, including self-referral.
- The role of a care navigator was defined, clearly setting out what they did and did not do. A care navigator does not give medical advice or try to assess a patient’s condition by, for example, asking for the patients’ temperature and then direct them according to these clinical parameters.
- A new phone system was installed in all eight practices with a shared direct line, enabling calls to be transferred between practices. Answerphone messages were changed to explain to patients why receptionists would be asking them questions, and a script was developed for all receptionists to use when taking calls. This was significant in giving all practices the same opportunities to navigate patients to the most appropriate care.
Involving patients in the changes was important to making the role of care navigators a success. One session was dedicated to communication and engagement with patients. Patient scenarios were played out to promote discussion between delegates and representatives from each Patient Participation Group (PPG) who attended. This was well received and led to the PPG helping refine some of the language used to explain signposting e.g. “GP” was replaced with “clinicians”, any reference to “primary and secondary care” was changed to “healthcare”.
Practices were keen to get feedback from patients following implementation of the signposting protocol. All surgeries are now working with Healthwatch to undertake random interviews with their patients.
- The eight practices have collectively released 227 appointments per week releasing 37 hours of clinical time. This equates to the practices having released an initial 5 per cent of GP consultation time, an average of 1 hour per week per whole time equivalent, through introducing active signposting in reception.
- GPs now have more time to spend on patients who need their care e.g. patients with chronic diseases such as heart disease, diabetes and hypertension.
- Patients receive a more consistent and high standard of care with the most appropriate person. In some cases this has provided more flexibility in how and when they can access that care.
- Receptionists from all eight practices have found the new process is working and overall very successful.
- Get a voice from outside your practice to help. The Learning in Action facilitators’ input was extremely powerful in driving forward the work and helping the practices keep the momentum going.
- Involve your PPG in any work you are starting around care navigation and signposting. Their support is key and can help you get your messaging right.
- Chunk up the work and share it out between practices, this will strengthen your collaborative working and speed up the pace of progress.
“Taking part in the programme has been a real eye opener. It’s been a great opportunity to find out what other practices are doing, to be able to talk to other receptionists. We are all in the same role but were all doing things slightly differently. Now we are all following the same protocols, which consolidate practice.
“I’ve gained a lot from listening to others and by sharing some of what we do at our surgery. I think I’ve been able to help other people as well.”
Kim Wolstenholme, Receptionist, Saxmundham surgery
“During the workshop I realised listening to some views that this initiative is a very big shift away from where the NHS was, and how we currently think about our NHS. But as a patient I recognised change has to happen if it’s to continue being effective in actually helping people recover back to a level of good health.
“It’s very important to remember change can make some people feel uncomfortable and perhaps vulnerable, I see our PPG team playing an integral role in helping our patient community understand how it works, the potential benefits and the intent behind it.”
Tara Foy, Chairperson – Peninsula Practice PPG
“I think the programme has been so successful because we already had the foundations for collaborative working. Deben Health Group was already working well together, but Learning in Action has focussed its thinking, and helped to think about working together on larger projects, instead of the smaller discrete ones that were already happening. The programme has also given people the tools, knowledge and confidence to take things to the next level.
“It’s fantastic that the group has developed such a high quality product (the protocols), and now they have the tools for improvement that can be used again and again in other projects.”
Emily Rawlinson – CCG, Primary Care Manager/Commissioning Implementation Lead
Abigail Woodley – apprentice at Wickham Market Surgery (coding and reception)