Pointing you in the direction of active signposting (AS)

Active signposting is a new triage system set to revolutionise the workings of GP practices. Practice Business takes a closer look

With GP burnout on the rise and average patient waiting times at an all-time-high, it’s vital that primary care diversifies its ways of working. This is why incorporating innovative methods of social prescribing can save your practice time and money, and can reduce the risk of your staff being overloaded by patient demand and piling admin.

Active signposting (AS) is a new triage system where non-clinical staff, at the first point of patient contact with the GP practice, and under the direction of clinicians, help patients access the most appropriate care at the earliest opportunity. This may be care given by other practice staff, a related clinical service or non-clinical services or providers. For example, a patient with repetitive strain could be signposted to a physiotherapist or a patient with chronic foot pain to a podiatrist.

Such a system ensures patients receive the care they need, whilst freeing up vital appointments for those whose ailments need to be evaluated by a GP. It also allows GPs to dedicate more time to these patients whilst relieving some of the pressure caused by too many appointments and too little time.

AS has been a success in the practices in which it has been implemented so far. However, it is still in its experimental phase. Waterside Medical Centre, in South Warwickshire, is a practice which identified active signposting as a priority; here’s their story.

Waterside Medical Centre underwent training in AS for six months. They attended six learning in action workshops, where they were introduced to new AS tools and techniques, such as the plan, do, study, act cycle, which provides a structured approach to improvement and allowed the practice to enter several cycles of active training and experimentation to test the following:

• How will patients respond to being directed away from traditional face-to-face GP appointments?
• What level of support will AS receive from the patient participation group (PPG) and staff at the engagement phase?
• Will patients object to non-clinical staff asking active signposting questions?
• Will reception staff accurately elicit details from patients and accurately record them in the reason for appointment?

During the study phase of the cycles the practice pinpointed the following actions as necessary for effective active signposting:

• Significant engagement with patient groups, staff groups and GPs to develop shared aims and objectives of signposting.
• A training and support package for practice staff with regular team review meetings.
• Keeping training current.

After experiencing some challenges with integrating AS into their surgery, such as technical difficulties with the ‘phone and some staff inertia, Waterside implemented a standard operating procedure, produced a ‘phone script information leaflet and created a newsletter to explain the new system to patients. Once these actions were implemented, the new triage system gathered excellent results:

• Active signposting helped the practice release 11% of inappropriate GP appointments, freeing up 80 appointments per week, equating to 13 hours of GP time. This has provided GPs with more time to focus on the patients who most need their help – for example, those with more complex care needs – as well as improving access for patients who need to be seen urgently.
• Feedback from the PPG has been very positive; results for the friends and family test have improved by 5%.
• Staff feedback has been very positive, with most pleasantly surprised by how positively patients have received the change and their willingness to share clinical detail.

The NHS has highlighted how important it is to have ‘clear aims, objectives and measures for any project of change you embark on’. This can then be implemented by motivating and educating your staff to endorse the change, as well as educating patients on the new system. Open and continued communication, therefore, is paramount for a smooth integration of active signposting in your practice.

If you are looking for innovative ways to make practice life more efficient for both staff and patients, active signposting may be an approach you wish to explore further. We hope our introduction has pointed you in the right direction!

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