Pressures on GP practices hit the headlines again this week when a new Minor Ailments Scheme was rolled out in North East Lincolnshire.

The scheme has been designed to provide locals with easy access to advice and medicine, encourage self-care for long term and minor conditions and enable people to avoid waiting to see a GP, as well as alleviating pressures from GPs.

People are being encouraged to consult their local pharmacist instead of a GP, and those who are exempt from prescription charges will receive the medicine they require to treat their minor ailment free of charge. People who pay for their prescriptions will also be able to receive advice and buy the medicines they require, if over the counter treatments are available.

Peter Melton, clinical chief officer for North East Lincolnshire Clinical Commissioning Group explained: “We encourage people to take care of themselves and treat their minor ailments and community pharmacists can now supply free medication for those who are eligible and direct the patient to other appropriate services. This will save people time, as they won’t have to get an appointment with their GP for a prescription.”

He added: “By making use of community pharmacy services, a Minor Ailment Scheme will provide many benefits to the provision of health care, such as; reducing the demand for urgent care at A&E departments, reducing the burden on GPs, and continuing to provide quality patient care and increasing people’s choice for self-care.”

There are 37 community pharmacies in North East Lincolnshire that are easily accessible with many open for longer hours than GP surgeries.

Effective signposting

While there’s nothing new about the above, the active promotion of the initiative is to be welcomed, as is the focus on more effective signposting. Recent stats suggest that 27% of appointments could and should be signposted elsewhere and, if a solid proportion of these appointments were reallocated, GP waiting times would be cut dramatically and workload pressures would be eased.

The hope of achieving exactly this was the reason behind a new initiative rolled out in West Wakefield earlier this year. A total of 57 receptionists in 6 practices across the area were trained to work as care navigators for patients, as part the PMs GP Access Fund.

The receptionists received training to enhance their ability to connect patients directly with the most appropriate source of help. When patients contact the practice, the receptionist identifies what their need is. They are then able to refer to information about services in the practice, other NHS providers and the wider care and support sector. Where appropriate, they direct the patient to these services. The system is also being offered through the websites of the practices.

Reception plus

One receptionist describes the initiative as “reception plus … it is trying to get the best for the person on the phone.”

Services to which patients may be signposted include:

• Practice and specialist nurse appointments in the practice
• Pharmacy First
• Physio First
• Acute ophthalmology services
• 111 in order to access an emergency dentist
• Mental health support including the local drugs and alcohol team, Big White Wall and others.
• Community support services for carers and older people

The receptionists are supported by access to up-to-date web-based information about local services in the health and care system. This is further facilitated by the provision of tablet PCs and web kiosks in the practice waiting room.

Positive results

Impact reports from the first few months have been positive. Since its inception, the Care Navigation service managed 6,366 referrals. Of these, just 26 were referred to a GP. In the first 10 months, an estimated 930 GP hours were saved across the 6 practices (64,000 patients).

Staff cite the wide range of options as a key part of the success, with Pharmacy First and Physio First making a big impact, together with direct signposting to social prescribing options. Use of the local Physio First scheme, for example, increased by 43% after the introduction of reception care navigators.

“Care navigation has taken a lot of the strain off GPs and given us more appointment slots,” one receptionist commented. “Now we help patients. Before there were no options so we just made them an appointment with the doctor.”

Receptionists themselves also find additional job satisfaction in this expanded role, particularly where it is newer to them and they have confidence in their awareness of the options available. “I feel a great sense of satisfaction when I have directed someone,” another said.

A smooth rollout

With signposting a great help to practices, how can you implement it effectively at your practice?

The good news is that there are loads of resources available to you. Firstly, a very handy free audit tool for you to work out how many appointments you can save can be found here. Also, NHS networks has published some handy advice, which is available here.

Meanwhile, here are some tips from the West Wakefield trial:

• Training for receptionists is essential, giving them both knowledge about the range of services available, confidence in understanding their suitability for different patient requests and practice in the process of matching a patient’s need to a service.
• It is worth planning to repeat this training after a few weeks of operating the new approach, to fill in gaps, build confidence and give staff the opportunity to encourage one another. This is particularly important for practices where receptionists have not previously undertaken any similar role.
• In the early days, staff confidence may be increased by the provision of a template or checklist to help them through the process of identifying what the patient is asking for and how they can best be directed.
• The information about services should be comprehensive, simple to access and up-to-date. Without all three of these, receptionists and patients are likely to lack the confidence to use it.
• If using a new website or device, give receptionists a chance to try it before they use it with patients. It takes time for staff and patients to get used to the new way of working. Allow for this, and plan to continually share learning and celebrate progress.

Have you used signposting with success? Would you consider introducing some kind of solution? What concerns do you have? Let us know by commenting below or in the forum here.

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