Rachel Madden, Clinical Triage Care Navigation Lead, and Dr James Perry, GP at Marine Lake Medical Practice ran a webinar in June 2022 explaining how they had implemented clinical triage using their administrative care navigation team. Below, we’ve shared their key advice for building a care navigation team so that your practice can apply their learnings.
Care navigators play a crucial role in coordinating person-centred care and support. They make sure that patients get the right support at the right time to manage their needs. The impact of this role has a growing evidence base in terms of the benefits for patients and the people and organisations that care for them. One NHS England case study suggests it could release 37 GP hours a week.
Like many practices, at the start of the COVID-19 pandemic, Marine Lake Medical Practice in The Wirral started using the ‘total triage’ model encouraged by the NHS. Whilst this allowed GP practices to continue supporting patients, they had to re-evaluate how they delivered care. With every patient needing to provide more information about their reason for contacting the practice, they introduced online consultations through eConsult to support triaging patient requests efficiently.
“For care navigation to be implemented effectively a whole GP practice approach is essential. This enables trained practice administrative staff to follow locally-developed principles – giving patients access to safe, efficient and effective information.”Healthcare Improvement Scotland
However, implementing an online consultation or triage system without changing workflow processes and standard operating procedures does not create efficiency. Your primary goal is for the patient to see the right person/service at the right time, first time. So, they took existing administrative team members and introduced a care navigation team alongside the processes to support them.
How to start implementing a triage system
Initially, the care navigation team in Marine Lake Medical Practice only actioned documented decisions about next steps and urgency; it was still a GP that read every eConsult and decided how the patient needed to be managed. According to Rachel, the transition to this role was easy due to past experience working in the traditional reception team. However, with online consultations, this process was far more efficient. Next, they would also upload eConsults into the clinical record as well as actioning decisions.
Both members of the admin team performing this role had only been in post for a year, with no prior experience of working in a GP practice. Through this early and basic level of navigation, following instructions only, the staff members were able to learn about the operating system and the appointment book. This was instrumental in evolving their role as care navigators.
In the two years since they started, they have grown to a care navigation team of six, supporting the 20,000 patients at Marine Lake Medical Practice. They now manage five times more eConsults every day than they did at the start of the pandemic when they would get 100 a day.
Between the information provided and our care navigation, we now send 70% fewer eConsults to the triaging GP.Rachel Madden, Clinical Navigation Team Lead
So, what advice would they give to practices looking to implement their own triage model, led by a care navigation team?
How to set up a care navigation team
The key responsibilities that the care navigation team in Marine Lake Medical Practice carry out have evolved over time as they gained confidence and experience. Everyone in their care navigation team sits in the same room as the triaging GP, so that they can ask clinical questions, have conversations and learn from the GP about how to triage based on the information presented in the Consult.
Your care navigation team’s make-up and dynamic might depend on your practice’s size and the volume of eConsults your practice gets. However, evolving the role to each person’s strengths will allow you to build confidence. You might also need to tweak internal processes as your team and their experience increase.
When building out your triage team, you might want to start by:
- Upskilling your care navigators in their understanding of your operating systems.
- Getting them to action pre-made decisions – make sure these are documented and signed off by clinicians.
- Supporting them to navigate decisions based on guidance documents and under supervision from a clinician.
- Finally, with confidence, your care navigators can move to unsupervised navigation.
The previously purely administrative staff now make triage decisions, under GP supervision or with their support, for a good percentage of incoming eConsults. This means that their GPs can spend time focusing on clinically relevant cases. The more experienced you become the more autonomous you become in your care navigation.
Building your team won’t happen overnight. It takes a while to gauge staffing levels, depending on how the practice adapts to triage, the volume of eConsults and the speed at which your staff can safely process and action the work.
In April 2021, 66% of incoming eConsults at Marine Lake Medical Practice went to the triage GP. By April 2022 they were only sending 20% to the triage GP. That’s 70% fewer eConsults sent to the triaging GP.
The most important thing is that your staff can work safely, without putting patients at risk. This means making sure that your team have a good understanding of their role within the GP practice and what is expected of them. If you’re a manager in a GP practice, you might be wondering what makes a good care navigator.
Skills to look for in a good care navigator
According to Rachel, the top skill sets to look for when building out your care navigation team include:
- IT proficiency – familiarity with the systems used in the practice and the ability to quickly grasp new processes.
- Confidence – your team needs to be in near-constant communication with the triaging GP, so they need the confidence to be able to ask questions and make decisions based on the information and guidance at hand.
- Empathy – your care navigators will be making decisions and communicating this to patients, so they need to be able to sympathise with patients and accommodate patient requests where possible.
- Attention to detail – there’s a lot of information to read and use to make your decisions, plus you then also need to communicate this back to the patient.
- Keeping calm – activity will be high, and your care navigators need to be comfortable being interrupted without feeling overwhelmed!
- Reliability and commitment – planning in rotas in advance will be key to ensuring cover, and regular communication with the clinical team is needed to update processes, brainstorm ideas and solve problems that arise.
If you’d like more detailed guidance on care navigation, Health Education England also has a three-tiered care navigation competency framework with core competencies across ‘essential, enhanced and expert’ navigation levels.
What does a care navigation team do?
The work you allocate to your care navigation team may depend on their size and the makeup of the people in it, but they are likely to carry out similar tasks and activities.
In Marine Lake Medical Practice their team allocate and manage incoming eConsults in the appointment book, which they have broken down into several lists:
- CCAS Triage – Patients redirected from 111 service – admin team call and ask for an up-to-date review.
- eConsult Admin – Any eConsult that does not require clinical input onto the “Admin” list.
- eConsult team triage – Any eConsult requiring attention from a clinician/clinical service.
- Triage GP list – This is the list that the GP actions – patients are booked on here from “Team Triage”.
- eConsult awaiting a response – Any patient who we are awaiting contact from (after requesting pics, for example) remain on here until received, then back to triage.
The following tasks are allocated between three people at their practice – two clinical navigators and one administrative navigator, but you may decide to allocate these differently, depending on the size and confidence of your care navigation team members:
- Uploading, triaging, documenting decisions, assigning patients to the appointment book and informing patients of the next steps
- Actioning the Admin list and the Triage GP’s list
- Checking the 111 list, awaiting response list and eConsult email inbox regularly
- Monitoring the response task box (the care navigation team assign themselves a task once they have actioned the awaiting response list, this serves as a safety mechanism to ensure patients aren’t missed)
- Rescheduling clinics when GPs or nurses are ill
- Keeping an eye on the appointment book for unused appointments
Support for setting up care navigation teams
While there might be a lot to think about when it comes to setting up your care navigation team, there are a lot of resources available to help you with this. The National Association of Primary Care (NAPC) can provide training to a range of frontline staff but this involves a cost.
There are also free resources available. For example, Healthcare Improvement Scotland has a care navigation toolkit available to all practices (not just those in Scotland) that includes specific topics on:
- Are you ready for care navigation?
- Delivering care navigation
- How to measure progress
- Sustaining success
The eConsult transformation team are also available to help you think about care navigation and triage in your practice, and how you can maximise your clinical time for those patients most in need. One of the resources we’ve created to help you is this template care navigation guide, based on the same type used in Marine Lake Medical Practice. You can find out more about how to use it and download it from our Help Centre.