Using ‘Active Signposting’ to streamline general practitioner workload in two London-based practices

Abstract

General practice is at the forefront of the National Health Service, but is currently being overwhelmed by ever-increasing patient demand and financial constraints. Telephone consultations (TCs) have been used as a method to ease pressure on general practice. Many of these consultations are booked with general practioners (GPs), despite occasions when the patient could have either been signposted to self-help or offered an alternative service. This quality improvement project (QIP) aimed to evaluate the nature of TCs undertaken by GPs at our two practices; and whether the patients’ needs could have adequately been met without the involvement of a GP. Consultations where this was the case were deemed ‘possibly avoidable’, and those where involvement with a GP was the best option have been termed ‘essential’. A retrospective analysis was undertaken to establish a baseline figure for the proportion of possibly avoidable TCs in two practices. A new intervention was then introduced, with reception staff following a set of protocols when booking in patients. Patients who did not require a GP to deal with their query were actively signposted by reception staff to other allied healthcare professionals, non-medical staff or an alternative service at the time of booking their appointment. Two practices were involved in the study. After 2 Plan, Do, Study, Act (PDSA) cycles, the proportion of essential consultations taking place at both practices increased from 28.6% and 27.3% at baseline, to 82.6% and 71.4%, respectively. A lower number of possibly avoidable TCs equates to more time for essential TCs and greater value for money for the practice. Patient access to care is also improved, with patients directed to alternative and often quicker services which still meet their needs adequately. With the current system of primary care unable to cope with the demands it faces, interventions such as active signposting provide value for both GP practices and patients alike.

A qualitative study exploring strategies to improve the inter-professional management of diabetes and periodontitis

“…With time constraints being common in healthcare, minimal disruption has been reported to be important in the implementation of clinical behaviours [47]. Active signposting has been shown to be effective in the context of reducing the amount of inappropriate GP consultations by triaging patients to a more appropriate healthcare professional [48]; and it is recommended in the UK NHS Year of Care initiative for managing long term conditions [49]. During the workshops, previous occurrences of indirect referral were described as acceptable by dental professionals in the case of suspected diabetes; and medical professionals suggested that indirect referral from a variety of sources was not only commonplace, but actually preferred over a letter or a telephone call.…”

The challenges of integrating signposting into general practice: qualitative stakeholder perspectives on care navigation and social prescribing in primary care

“…Other studies have also highlighted the importance of training and skills in CN and SPLW roles. The success of a CN intervention evaluated across two practices (8) was in uenced by staff training in the use of the CN protocols; a realist review (17) identi ed that su ciently trained and knowledgeable link workers enabled the successful transition of patients between services.…”

“…CN staff had grave concerns about failing to recognise serious health issues when patients presented for help, and risking patient safety by inappropriately diverting them away from GP appointments. Although it has been highlighted previously that any signposting should privilege patient preference and safety, it is also evident that even experienced clinicians vary in their assessment of what constitutes a potentially avoidable appointment request (8). This raises concerns about the advisability of CN receptionists managing risk in the unpredictable setting of general practice, where even quali ed and experienced clinicians must develop risk-management skills over time (31).…”

The challenges of integrating signposting into general practice: qualitative stakeholder perspectives on care navigation and social prescribing in primary care

“…Whether the CN role is meeting these expressed aims is currently unclear. One small-scale peer reviewed study [8] and two case studies [9,10] suggest that care navigation can reduce the number of 'potentially avoidable' [8] or 'inappropriate' [9] GP appointments carried out by practices. For example, over a 7-month period, care navigation was calculated to have saved 1,685 GP appointments across an area in the North of England [10].…”