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Success Stories Showcase: Active signposting

Making healthcare accessible is crucial for GP practices, according to the Department of Health. After all, as part of the GP Forward View, it has committed £45m fund to contribute towards the training of practice reception and clerical staff with the aim of ensuring that they are well-equipped to undertake an enhanced role in active signposting and the management of clinical correspondence.

In a nutshell, active signposting provides patients with a first point of contact which directs them to the most appropriate source of help. Usually, this involves receptionists acting as care navigators can ensure the patient is booked with the right person first time, while web and app-based portals can provide self-help and self-management resources as well as signposting to the most appropriate professional.

Putting it into practice

When it comes to active signposting, many CCGs, GP federations and individual practices have already rolled out ideas that are starting to make a difference.

For example, Waterside Medical Centre in South Warwickshire, which has six GPs and almost 13,000 registered patients, turned to active signposting to improve how it managed its rapidly increasing patient list. The practice participated in the Learning in Action element of the Time for Care programme by NHS England’s Sustainable Improvement team, available through the General Practice Forward View.

According to an NHS England case study that’s referred to as an example of best practice by NHS Networks, the practice utilised The ‘Plan, Do, Study, Act cycle’, which provides a structured approached to improvement, enabled the practice to undertake a number of cycles to test the following:

  • How will patients respond to being directed away from traditional face-to-face GP appointments?
  • The level of support from the Patient Participation Group (PPG) and staff of active signposting 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 found it needed to take the following actions to effectively implement active signposting.

  • Significantly engage with patient groups, staff groups and GPs to develop shared aims and objectives of signposting.
  • Develop a training and support package for practice staff with regular team review meetings.
  • Ensure training is current.
  • The practice worked through the actions between each workshop and brought back their learning and progress to share with the group to get their feedback, input and collaboration in progressing certain actions.

Overall, The programme helped the practice release 11% of inappropriate GP appointments, which equates to 80 appointments per week or 13 hours of GP time. GPs at the practice say this has allowed them to focus on those patients that need their time (e.g. those with more complex care needs), as well as improving access for patients who need to be seen.

Feedback from the PPG has been very positive, results for the friends and family test have improved by 5%. Crucially, 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.

Another example

Another practice that has successfully implemented active signposting is at AT Medics, where the demand for GP appointments at all of its 26 surgeries is extremely high.

“One day we had a fully booked clinic and were extremely busy,” explains Katie Rack, Practice Manager at Edith Cavell Surgery, one of AT Medics’ South London practices. “A parent with a very sick child phoned up desperate for an emergency appointment that day. We made the decision to squeeze their appointment in as it was urgent, but it got us thinking – how could we have avoided that happening?”

The clinical and administrative team at the surgery looked back through all the appointments for the day’s clinic and realised that there were a lot of patients who had come in to see a GP who could have been helped in a different way. “We estimated that about 60% of patients coming in to see a GP didn’t need to and could have been signposted to a different service instead,” explains Katie.

As a result, the team decided to test signposting to see if they could successfully solve some patients’ problems before they came in to see a doctor, thereby freeing up their appointment slot. Patients who could see a different clinician, a pharmacist or be signposted to another service altogether were proactively identified and contacted with information about how they could avoid having to come and see their GP by following a different route. Further information on this case study can be found here.

“For example, we had a lot of patients booking GP appointments to get a prescription for medication,” says Katie. “We spoke to these patients and let them know that they could order a prescription on our website, and successfully freed up their appointment slots. Other examples of the types of appointment that we can free up through signposting include patients who want a repeated sick note, who are collecting test results, or those who want to be prescribed contraception.”

Training

Vitally important to the success of active signposting is the upskilling of reception staff. This is a topic we’ve touched on before on the Practice Index Blogclick here to read more.

Funding for training is available via the GP Forward View – further information can be found here.

Optimising websites

While the upskilling of receptionists is a vital element, a key part of signposting at AT Medics is each practice’s website, which have each been developed to incorporate a host of online services.

Patients can create an online patient account via their practice’s website, which they can then use to book and cancel appointments, request repeat prescriptions, view test results, message their GPs directly and even access their medical records.

“If a patient phones and asks to book an appointment for a repeat prescription, we would signpost them to our website and let them know that they can order it online without needing to come in,” explains Katie. “We also proactively tell patients about our website when they phone or come in for an appointment, so that we can raise greater awareness of the online services we offer.”

The online services and active signposting protocol allows AT Medics to meet their goal of making accessing quality healthcare as easy as possible for their patients. “Accessing your bank account or gas bill online is simple, quick and easy – why should healthcare be any different?” Susan Sinclair, CEO, points out.

Active signposting is, quite rightly given the above examples, a high-impact action many CCGs and GP practices are focusing time and effort on. The thought of providing a service to more patients than before, without having to increase our number of GPs is, after all, a compelling one.

Active signposting is a topic currently being discussed in the Success Stories Showcase section of the Practice Index Forum. For more insights and advice from practice managers on this topic and to join the conversation click here.

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