Making healthcare accessible is crucial. As part of the GP Forward View, the Department of Health has created a new, five-year £45m fund to contribute towards the training of practice reception and clerical staff. The aim: to ensure that they are well-equipped to undertake an enhanced role in active sign-posting and the management of conical correspondence. Nick Sharples, managing partner of DNA Insight, explores ‘active signposting’ and shares six secrets to doing it effectively
With the GP Forward View strategy now well established, many CCGs, GP federations and individual practices are seeking to commission training in the two high-impact actions (HIA), for which NHS England has provided ring-fenced funding.
‘Active signposting’ is one of these two HIAs and has the potential to save up to 26% of GP consultation time if fully and effectively implemented. But how do you introduce active signposting in such a way that the potential savings are optimised? And, what do you need to consider when commissioning such activity?
Having trained many hundreds of practice managers and GP receptionists across the country in active signposting, we have identified six key elements of success which, if adopted, are likely to result in a successful implementation of care navigation and a realisation of the significant savings to be had in consultation time.
So here are our six secrets to active signposting success – key factors to consider when introducing active signposting to your practice, federation or CCG.
Preparation is Vital
The key thing to bear in mind is that active signposting will bring a change to the way in which the practice currently operates and it will affect the entire practice community – albeit for the better. The training of the reception team is just half of the equation for a successful implementation. The second half of the equation deals with how effectively the programme is introduced to the practice – and responsibility for that lies with the GPs and practice manager.
When you are in the early stages of commissioning training for a federation or CCG, consider inviting a training provider to come to one of your GP and practice manager meetings to explain what is involved in the training and subsequent implementation. They will certainly cover the nature of the training they offer – but they should also be prepared to discuss, and provide you with guidance and best practice on those areas that need to be put in place prior to the signposting ‘go live’ date.
These should include:
- The need, scope and creation of a service directory (start small and build over time);
- The building of an EMIS or SystmOne template to allow signposts to be recorded and exported for analysis;
- The need for red flag protocols to be articulated, written down and available to receptionists;
- The need for the GPs or the federation/CCG to decide which of the available alternative services (in-practice or outside in the community) offer the most potential for early signposting wins. These services should be amongst the first to be introduced but will almost certainly need some additional consultation to ensure they are ready for the increased flow of patients. (Where available, pharmacy and MSK/physio related services top the charts for delivering the greatest numbers of signposting opportunities.)
All of these activities can be developed concurrently while you are going through the procurement process for a training provider, but ideally, they should all be in place before the training of your reception team starts. In that way, your receptionists can train on scenarios that will be immediately relevant when the Signposting starts.
Engage the whole practice community
Whilst there are some training courses where you can just send people away on a course and expect change to magically happen, active signposting is not one of them. GPs, practice managers, clinical staff and external service providers such as pharmacists and physiotherapists all need to be engaged in the programme for the genuine benefits of active signposting to be realised.
Almost every practice in the country is unique in its staffing structure, patient demographics, challenges and ambitions – and a ‘one size fits all’ training programme will end up not suiting any of the practices. The training programme offered by your provider should be bespoke to your specific needs. They should take time to understand the local dynamics of the practice and the wider federation or CCG within which it operates – customising the training accordingly, so that it is both relevant and valuable.
Face-to-face or online
Whilst some training works well when delivered remotely, in active signposting it is the face-to-face practice and the interaction with colleagues that goes a long way to making sure the techniques will be adopted on return to the practice.
Trying out new techniques in a safe training environment, with a colleague on the end of the phone playing the role of the patient, provides the necessary self-confidence for Receptionists to introduce the techniques when they finish the training.
Bring everyone to the training
Many of our feedback forms highlight how the training was very valuable, but would be more so if it was attended by the GPs/PM as well. Encourage your commissioners, practice managers and GPs to attend the training, alongside the reception team.
Such high-level attendance not only empowers the receptionists with the authority to apply the techniques they are taught, it also exposes managers and GPs to the realities of life behind the reception desk. A member of the practice management team will then be on hand to answer the inevitable Practice specific questions that arise during the scenario role play.
If training budget is an issue, consider running a pilot with a complete practice team or several. This is far preferable to trying to spread the knowledge across the organisation by training a couple of receptionists from each practice and then hoping that they will magically be able to train their colleagues when they get back. Whilst nice in principle, it almost never works in practice.
Promote the service to your patient community
Active signposting is a win-win for all members of the practice community and the patients are no exception. Making them aware of the introduction of active signposting/care navigation will encourage them to share their symptoms with the receptionists, which will allow a signpost to be offered.
There are many ways to promote the introduction of care navigation but one of the most effective is for the senior GP to record a message on the front end of the practice phone system, so it is heard by every patient who calls the practice. The voice of an authority figure asking you to do something (in this case sharing your symptoms) is a powerful concept in behavioural psychology and will greatly increase the number of patients happy to share their symptoms.
Have a formal ‘go live’ date
It’s not unusual in our experience for the training of the reception team, and the separate but necessary preparation of the service directory, data collection template and consultations with chosen service providers, to get out of sync.
It is important however that all are in place prior to your ‘go live’ day. As the saying goes, ‘You never get a second chance to make a first impression’. With so many stakeholders involved and affected by the change, getting it right first time is essential.