In our latest article on how we can ease the burden on a stretched NHS, Becky Gulc considers a strategy to direct some patients to other health professionals aside from GPs
The relationship between people and the NHS needs to change. Reduced spending on social care in conjunction with an ageing (and growing) population, poor lifestyle choices and staff shortages means that pressures on the NHS are greater than ever.
NHS figures have shown high increases in the number of people waiting at least a week to see a GP in recent years.
This is set in the context of millions of missed appointments each year. As many as one in four GP appointments could be defined as needless. These are cases where people didn’t need to see a health professional, could have managed with self-care, social prescribing or been treated by another professional such as a nurse or pharmacist.
Research commissioned by NHS England also shows that around a fifth of GP workload might be better handled by someone other than the GP.
One of the ideas for freeing up GP time and working towards increased efficiency in the system relates to active signposting, one of 10 High Impact Actions (HIAs) aimed at responding to challenges identified within the General Practice Forward View.
The idea is patient’s first point of contact would direct them to the most appropriate source of help, whilst often this will be to a GP this won’t always be the case.
Qa Research have been supporting CCGs to consult with members of the public about these HIAs. What we’ve learned so far is that people understand the rational for active signposting and are in favour of it. They can see that this could potentially improve efficiency, reduce waiting times and result in cost savings from making better use of GP time.
Despite this the extent to which people back this shift is very much conditional on signposting being done correctly. There are fears and concerns amongst the public which will be challenging to overcome.
There are concerns regarding the responsibility this places on reception staff to navigate people to the right service. The risk of ‘getting it wrong’ is considered too great for some.
There are fears of delays in diagnosis, misdiagnosis, and hidden needs not being unpicked (e.g. physical symptoms masking mental health issues).
“Would receptionists really be trained to know?”
A key concern is that vulnerable people, particularly the elderly, could fall through the net, downplaying symptoms and then perhaps not being signposted to a GP when they are the most in need.
“Possibly could miss bigger and more serious symptoms such as cancer and heart disease”
This fear and mistrust is set in the context of GP’s being seen as the ultimate ‘professional’ that people trust to diagnose. It’s also set in the context of the negative connotations some people hold of practice receptionists: obstructive, terse, cold.
“Who decides who sees the professionals?”
“People often feel judged by receptionists. People need to feel comfortable talking about their conditions with a receptionist.”
Are these the right people to navigate people to the right professional or service? There’s a question mark over this for many people – in particular in terms of their skills and knowledge and how people feel about answering questions about their ailments to these members of staff.
Two key considerations
So how can CCG’s combat these fears when they develop active signposting? Here are some considerations based on our research:
- Labels matter. Does the title ‘receptionist’ convey trust, access, knowledge? Think about alternatives whilst being true to the skillsets people have. Some alternative suggestions we’ve had include: Patient Liaison/Support; Health Assistant.
- Be transparent. First contact staff will undoubtedly receive training on how to navigate people to the right service/professional but it is perhaps key that the public are made aware of this training and that this shift towards signposting is happening. They need reassurance that signposting is a considered exercise with input behind the scenes from all levels of staff, a process which is regularly evaluated in practices.
“Educate public to make them aware of the system so they understand why receptionists might ask. Market on TV, radio, online. Make them aware it’ll save time and be quicker.”
Becky Gulc is a research manager at Qa Research. You can contact her on firstname.lastname@example.org or 01904 632 039