GP practices have varied experience of care navigation. However, whatever previous experience a GP practice has, there are a number of steps to consider before embarking on this work.
- Step 1: Find out if your GP practice is ready for care navigation
In order to be prepared for the work that lies ahead, using the readiness tool will help you to understand:
- current ways of working within your GP practice
- the motivation of your staff to develop, test and implement care navigation, and
- GP practice resources and abilities to develop, test and implement care navigation.
Downloadable Resource: Care Navigation Readiness Tool
- Step 2: Talk to your team about the work
For care navigation to be implemented effectively a whole GP practice approach is essential.
All members of the GP practice team need to be aware that this work is being undertaken. You will then have to consider:
- Who will lead the work?
- When are you going to meet and how regularly?
- How are you going to communicate? Don’t forget wider team members such as locums.
- How are you going to involve patients and carers?
- Step 3: Understand your current GP practice
GP practice teams need to carry out a number of steps to help them understand their current knowledge of care navigation, processes and available resources within the GP practice.
- Identify the level of care navigation currently happening.
Downloadable Resource: Care Navigation Data Collection Template
- Find out what your staff currently know and understand about care navigation and the resources available.
Downloadable Resource: Care Navigation Staff Questionnaire 1
Downloadable Resource: Care Navigation Staff Questionnaire 2
- Identify current primary care services available – remember to consider future services.
- Find out what your patients currently know and understand about care navigation and the services currently available to them.
Downloadable Resource: Care Navigation Patient Awareness Questionnaire
Every GP practice team member will have some knowledge of how a GP practice’s processes work in relation to care navigation. To ensure an accurate picture, it is helpful to map your current care navigation process with your team. This can be done by process mapping.
The benefits of process mapping:
- to capture and visually represent all the steps in an existing process
- to show everyone in a team how a process works in practice now, rather than what they think is happening
- to help identify change ideas for improvement
- to visually represent a new process
- to assist team building as it should involve all team members in accurately capturing current process and the design of any new process, and
- to map out the patient journey so that you can find out how many steps it takes to get the patient to the appropriate person.
An example of how a PASC phase 1 team has mapped its processes for care navigation:
Downloadable Resource: Care Navigation flow chart
More information on process mapping and its benefits here.
- Step 4: Measure what is currently happening
“To measure is to know – rather than assume – what to improve, where to improve and whether you are successful in your efforts to improve.”
– Ross Davies, Data & Measurement Advisor, Healthcare Improvement Scotland
In order to understand your system and how it can be improved, it is important to measure current care navigation activities over a short period of time (baseline data). This may involve a manual count.
Fun and innovative ways of measuring progress can be used such as fishbowl counting. This method involved PASC phase 1 GP practices dropping a pebble in a bowl every time a member of the administrative team had a conversation with a patient about about care navigation and/or a patient expected an alternative appointment to a GP.
Teams within the collaborative found the “week of care audit” a helpful resource. It helps to identify where a patient could have been seen by another service provider first rather than the GP.
Downloadable Resource: Week of Care Audit
PASC phase 1 teams developed a template on the EMIS patient access portal to assist with data collection:
Downloadable Resource: EMIS Template and installation instructions
Increasing patient awareness and knowledge of other primary care services that are available has been found to be helpful. PASC phase 1 teams developed a questionnaire to find out what patients knew. This questionnaire can be downloaded here:
Downloadable Resource: PASC Team Questionnaire
- Step 5: Identify your resources and what you need
You should consider the following when process mapping your local system to help you identify your existing resources.
- Where are you in the care navigation process?
- Are your patients offered information and informed about other services?
- Do you have any frameworks and guidelines for care navigation that you are using in your GP practice?
- Do you have staff available and trained for care navigation?
- Contact your indemnity provider to discuss proposed work and consider any GP practice implications
- IT systems – do you have any electronic means to record care navigation?
- Does your reception space allow for confidential discussions with patients?
- Step 6: Identify and provide staff education
Identifying the staff training needed to progress this work is crucial. Providing training and education for care navigation can result in an increase in job satisfaction, morale and confidence.
Learning from the collaborative suggests that a mixture of in-house and external training is beneficial. This can be achieved by working with other GP practices and inviting local experts or external training providers into the GP practice.
Downloadable Resource: training providers used by our PASC teams
- Step 7: Involve patients and carers to ensure effective communication
It is essential your GP Practice establishes clear methods of communication with patients and carers about the services your GP practice provides and methods of sign-posting to other health and care providers.
PASC phase 1 teams worked with patients, carers and local communities to develop a range of resources to support communication.
The following resources have been created by our PASC teams:
Downloadable Resource: Patient Information Leaflet 1
Downloadable Resource: Patient Information Leaflet 2
Downloadable Resource: Patient Information Leaflet 3
Digital Signposting and self-care advice
Care navigation can also help people to care for themselves and their families.
NHS 24 can provide a range digital resources and services that supports self-care advice and information (including but not limited to) NHS inform, Scotland’s Service Directory, Self Help Guide, Care Information Scotland, Quit Your Way Scotland, Immunisation Scotland, Screening Scotland, Ready Steady Baby.
All of which can underpin the care navigation and Signposting role for practice staff. This would result in consistency of approach, quality standards and effective communication and networking across the Primary Care community.
NHS inform is Scotland's national health information service. It provides accurate information to help people make informed decisions about their own health and the health of the people they care for. The website has enhanced features and interactive digital tools to allow people to tailor the information, making it more personal to them.
- Self Help Guide: fully revised, updated and aligned to the 111 service the new Self Help Guide allows you to check your symptoms online and get advice to manage your condition or signpost to the right service.
- Scotland's Service Directory provides easy access to a range of health and wellbeing services
- Info for Me is a personalisation tool, which enables people to bring together information relevant to them into a single place, which can be easily printed saved or shared
The toolkit provides digital assets that can be used in a range of different ways including:
- Wording to support messaging in newsletters etc.
- information screens in your practice
- practice website and Social media channels
It can be found here.
We’ll keep you right
'We'll keep you right' is a campaign made up of a variety of digital assets delivered by NHS 24, (on behalf of NHSScotland).
The ‘We’ll keep you right’ campaign provides simple information on the range of services that are available to help people across Scotland to access the right treatment, by the right service, at the right time.
This campaign includes a range of digital assets which have been produced in a range of sizes for you to display on your website and waiting room screens along with a link to www.nhsinform.scot. Please let us know your size preferences by emailing firstname.lastname@example.org
There are also a range of NHS inform and 'We'll keep you right' resources such as leaflets and posters available for download or hard copy versions can be requested from email@example.com
- Step 8: Check you are ready
The following checklist can help you find out if you are ready to progress with delivering care navigation. If you are ready you will have:
- an understanding of what care navigation is
- established your team and how to communicate about the work
- gathered baseline information
- an understanding of your current practice
- an understanding of your current resources
- established what resources community colleagues have
- established staff and patients’ understanding of care navigation, and
- made sure staff have the skills and confidence to undertake care navigation.