The positive changes that have been adopted across the healthcare system as a result of challenges we faced during the Covid-19 pandemic have been well documented and in our previous podcast and blog we highlighted increasing public recognition of the value and role of community pharmacists. Whilst the role of Care Navigators is being implemented right across general practice between now and March 2024, it has existed in a number of practices and pharmacies for some time and Professor Ash Soni OBE, President of the National Association of Primary Care (NAPC) and a practising community pharmacist explains, later in this blog, that counter staff and pharmacy technicians were trained in Care Navigation as far back as 2016.
The NAPC are the founders of Care Navigation training, a bespoke programme that we have been delivering to healthcare systems across the country since 2009. At the time, we identified an opportunity for a range of frontline staff in primary care – including receptionists, administrative staff and pharmacy assistants – to improve access to primary care services by training them in key skills such as active listening and how to signpost people to sources of help, advocacy and support. We found that by upskilling existing staff it had the potential to help to reduce unnecessary appointments, increase patient wellbeing and maximise resources already in the system.
As we embark on delivering the NHS England funded roll out, we spoke to Sheinaz Stansfield, Practice Manager in Gateshead about the evolution of the role. As a pioneer practice involved in the early stages of the development of the role, she explains that it was identified as part of the ‘day job’ by two of the practice receptionists, Julie and Jayne, as they booked a number of repeat appointments from patients. Sheinaz explained that they were naturally ‘case finding’ and recognised that certain patients could be better served and supported by other services. The practice was already very interested in population health and health inequalities and so it was a natural step to embark on the Care Navigation training as part of the initial pilot.
Sheinaz explained that when they first started Care Navigation they had a number of homeless people, refugees and asylum seekers registered with the practice, in addition to frail elderly patients and those with early dementia, who would benefit from support from other agencies who are best able to meet their needs. Julie and Jayne trained as Care Navigators and subsequently worked with colleagues from organisations such as Age UK and the Salvation Army investing time and making good relationships to establish excellent resources across the community. Through the outstanding work of the Care Navigators, the practice was effectively adopting the Integrated Neighbourhood Care approach pioneered and championed by the NAPC for the past two decades.
Sheinaz describes the power in working with external agencies on joint bids for funding for example to provide additional services for people needing support with their mental health, demonstrating the benefits of collaborative working with care navigators, link workers and social prescribers being a core component of this. The Gateshead Practice have been championing social prescribers since 1998 and working with Mark Swift from the former Holton CCG these projects went on to inform the social prescribers network, now written into the PCN contract and recognised as valuable members of the integrated neighbourhood teams.
It is important to remember that appointments to see a GP increased by 20% throughout the pandemic and in the recently published delivery plan for recovering access to primary care there is an ambition to offer 50m additional appointments in general practice by 2024. Given the ongoing workforce challenges and the increasing complexity of conditions that people are presenting with, it remains vital that the wider social determinants of health needs are met whilst freeing up appointments with GPs who are then able to focus on people with more complex clinical conditions.
Julie and Jayne went on to develop their roles and careers through experiential learning and formal education and remain in the practice. Jayne is an assistant lead nurse managing year of care reviews and utilising the experience she gained as a Care Navigator thinking about the whole person and what that person needs, signposting to other services and streamlining the patient’s journey. Similarly, Julie is in a role leading the complex care team again utilising the knowledge and skills she gained during her time as a care navigator. Both Jayne and Julie also continue to mentor and support others.
A valuable message from the discussion with Sheinaz was the importance of receptionists in the general practice team, who she describes as ‘a valuable asset, the heart of the team’, and we couldn’t agree more. They are the ambassadors, who we should celebrate and support as they are the first line and contact for patients both on the telephone and in person. In the Gateshead practice of 17,500 patients, eight receptionists answer as many as 1500 to 2000 calls on a Monday, a proportion of whom will need a call or face to face consultation with a GP, but others can be signposted to another health or care professional within or allied to the practice or wider PCN.
Within the community pharmacy setting, health and wellbeing advice has been administered along with prescriptions or a purchase in Professor Ash Soni’s pharmacy since 2016. A key part of the community pharmacist’s role is enabling people to seek the best advice for them and supporting them in whatever their need is. The public recognise that staff in the pharmacy have the knowledge and skills to help them maintain their health and wellbeing.
Prof Soni describes how they started to recognise that some people would make frequent trips to the pharmacy to collect a prescription that they had collected only days before suggesting a degree of forgetfulness. They so looked at how they could support these people with some funding they received for a dementia project, took advantage of the training being offered by the NAPC and shared the learning and spread the skills within the pharmacy.
The impact has been a change in the public perception of pharmacy staff as part of a care team rather than someone just in position to sell something and for the staff trained in the skills there was a sense of status over and above being ‘counter staff’ and getting greater satisfaction in the role of a care navigator.
Professor Soni advocates having care navigators in all parts of the system so that people can be directed to the right service or person to meet their needs, Care navigators in the dentist surgery or optometrist or community team or wherever people access services or support is a very positive benefit, not only to those people accessing those services but also those in the various roles that allow them to develop their career and find greater job satisfaction as a result.