Over the last few years several new terms and roles have entered the primary care vocabulary; Social Prescribing, Signposting and Care Navigation. So, what do they all mean, what is their relevance to everyday general practice and are they the solution to the current pressures facing GP’s and GP Practices? They certainly underpin most of the 10 high impact actions devised by NHS England in the GP 5 year Forward View.
Many similar initiatives and enhanced services are launched by the NHS in what I refer to as a ‘Spray & Pray’ manner, spray it out there and pray it works. But as a Practice to implement a new service you not only need buy in from your staff, time to produce new protocols and processes but also to convince your patients and staff it’s a brilliant idea. All whilst doing the day job! Having somebody else analyse, understand and disseminate new initiatives is always a god send.
So, what is social prescribing, signposting and care navigation?
There are many different definitions and explanations all of which seem to overlap each other, especially when referring to Signposting and Care Navigation.
A GP colleague and myself set ourselves a task, to try and understand the difference between signposting, care navigation and social prescribing, what were the benefits and values of each and how could they work together to enhance patient outcomes. This sparked an amicable debate that continued for several weeks, one of us coming from a clinical point of view and the other from an operational angle. We went around in many circles, ever decreasing you might say, until we finally came up with an answer that we both felt defined our original remit.
We both agreed that signposting and care navigation are separate activities but are on the same spectrum of care, with more experience and training needed as you move from Signposting through to Care Navigation. The words actually explain themselves- like a signpost in the road directing you Signposting is a relatively brief one-off episode whereas as the Care Navigation is a journey helping a patient to navigate their way around their health and health services. Social prescribing encircles both being a tool used to aid the desired outcome for more person-centred care.
Social Prescribing is, in essence, a community referral which can be done by clinicians and non-clinicians alike. It’s a tool to de medicalise conditions and situations that don’t need medical interventions.
Some might feel it’s a fad and believe that General Practice has been using a form of social prescribing for years, which it has. But surely this was done best a few decades ago, when the demands on primary care were much less and when families and communities where more cohesive.
Practices have engaged with Social Prescribing across the country in varied ways, maybe not always seeming to have fully understood or embraced the concept, for example social prescribing isn’t just holding a Zumba class once a week in the practice. But there is no manual for social prescribing and one size doesn’t fit all, each GP practice will differ greatly in its population age and size, deprivation and social isolation and surrounding resources and services. All these different factors will determine how you are able to approach, mould and develop your service.
Signposting is likely already being done by your receptionists but there are now training courses to help standardise and enhance this skill. It is the bronze or essential level in Health Education England’s Care Navigation- Competency Framework. ( https://www.hee.nhs.uk ). It normally involves a brief assessment and conversation with a patient to help filter out those patients that do not need to be seen by a GP, they can then identify the correct healthcare professional or local service most appropriate for the patient’s presenting condition. For example: pharmacist, GP, Nurse Practitioner, District Nurse etc.
A Care Navigator is a separate, new, nonclinical role, matching the Enhanced or Silver level in the HEE Care Navigation: Competency Framework. They are normally level 3 or 4. As a member of the practice team the Care Navigator has time to have a more in-depth conversation with a patient either before or after they have been seen by a clinician and a diagnosis has been made. Part of their role is to help in management of a patient by encouraging and supporting behavioural change and enabling de-medicalising of problems, where appropriate, through a more holistic approach and will often involve referring a patient to social, community or voluntary services in the local area. For example: weight watchers, healthy walking groups, knit and natter etc.
The HEE also has described a third level- Expert or Gold, where a Care Navigator takes on more of a leadership role, for example helping to develop services within the local community to meet an unmet need. So, it seems the seeds are now being sown for a new role in primary care which reaches out into the community, and no doubt in time will come qualifications and apprenticeships to support it.
So, what is the evidence for the impact of these new roles, it’s early stages but evidence is beginning to be collected showing improved outcomes with patients reporting less anxiety and improved quality of life (KF) as behavioural changes and support help to build people’s self-confidence and resilience. A lot of evidence still sits in individual patient stories. For example: a patient had moved to the area and was seen by the local GP. This patient was very low and suffering from depression following an accident that had left him wheelchair bound, so the GP asked a care navigator to contact the patient to see if she could help in anyway. She popped in to see him one afternoon and over a cup of tea the patient explained that prior to his accident he had been a regular church goer but being new area and disabled he was unable to get to the local church and this had left him feeling isolated and lonely. The care navigator did no more than walk down the road to the Vicarage, knock on the door and have a conversation with the local Vicar. She discovered that the local church ran a voluntary transport service for parishioners that could not make it to church themselves and they could collect the patient from home and bring him to the church as often as he wished. 6 months down the line the patient has a busy social life and friends he sees regularly, he no longer feels isolated and lonely and is no longer on anti-depressants and has a positive outlook on life.
So, is it a myth? No, it is not.
Is it the solution for 21st century general practice? Yes, we believe it is, now and in the future.
Operational Director Co-Formation ltd.
Our Mission… to focus on innovative changes in Primary Care… to help produce collaborative and sustainable solutions… with practical hands on support to facilitate change
GP workshops etc available and support implementing new roles etc
Visit our website: https://www.co-formation.uk/ for more information.