1. Intros

2. Care Navigation West Wakefield Health & Wellbeing
Multi-specialty Community Provider Vanguard
Care Navigation
West Wakefield Health & Wellbeing
David Cowan
Care Navigation Programme Manager

3. Wakefield District West Wakefield 6 Practices 64,000 Patients
Networks 3, 5 and 6
18 Practices
162,000 Patients
Wakefield District
40 Practices
332,000 Patients
The Journey, the spread
PMCF
Vanguard Year 1
Vanguard Year 2

4. The MCP’s Hypothesis
The new model of care has been designed to achieve the four objectives of the Quadruple Aim (variation of Triple Aim).
50% of work done by GPs could be carried out by a more cost effective resource
Lower Cost
Improved Patient Experience
Improved Patient Outcomes
Improved Staff Experience
The Hypothesis 50% of work done by GPs could be carried out by a more cost effective resource
The Quadruple aim, the New models of care were all created with the quadruple aim in mind: Lower cost, Improved Patient Experience, Improved Patient Outcomes, Improved Staff Experience

5. Pharmacists In General Practice
The Vision For General Practice
General Practice
Care Navigation
Pharmacists In General Practice
Physio First
Social Prescribing
Extended Access
Schools App Challenge
HealthPod
Health Champions
West Wakefield retain extensive knowledge about the implementation of these system components

6. Decreasing number of GPs Increasing number of patients
Why do Care Navigation?
Decreasing number of GPs
‘Recent NHS Figures have shown the number of GPs in the country dropped by almost 100 in the past year, down to 34,495 full-time equivalents in September 2016 compared to 34,592 the year before’
Increasing number of patients
‘The 513,000 or 0.8% rise in the number of people living in Britain in the year to June 2015 was similar to the annual average increase over the last decade.’
The context: decreasing number of GP, workforce plans to increase numbers of GPs but the demand is far too great right now, with an increasing population year on year, especially in the older generation

7. Why do Care Navigation? GP forward view 2016 widening workforce.
Care Navigators will be pivotal to navigate to the extended primary care team and local services
Patient’s receive the right care, by the right professional, at the right time.
This means one visit, not two for the patient.
Improved job satisfaction for frontline staff.
The Care Navigators now receive thanks from patients
Link back to the Quadruple aim. Lower Cost, Improved Patient Experience & outcomes, Improved Staff Experience.
Video to be used if required.

8. Care Navigation Definition
“A person-centred approach that uses signposting and information to help primary care patients and their carers move through the health and social care system as smoothly as possible to ensure that unmet needs are met”
Care Navigation didn’t have a set definition when the journey started, we’ve developed a model locally that works for our patients and practices.

9. Extended Primary Care Team
Care Navigators
Physio First
Pharmacists in General Practice
Advanced Nurse Practitioners
Health & Wellbeing Workers
Mental Health Workers
Health Champions
Care Navigation pivotal to extended the primary care team, acts as a gateway to these new clinicians

10. Service Access Information
Example of one of our access criteria.
Allows Care Navigators to safely navigate patients to a service or clinician. This is something that we help with when spreading to other districts.
The receptionist can use the list of access criteria and print off a patient information leaflet too.

11. Service Access Information
Further down the access information is explanations on what the services do, so if patients ask they have this as a reference.
There is also lists of local services their information such as opening times, addresses and contact details

12. DoS – Self Care
The DOS is about promoting self care. There as hundreds of groups which are local to the wakefield district and some that are national.
This was initially considered for use of the Care Navigator, we found it was too time consuming for our receptionist. This is now used as a tool for patients for them not have to rely on primary care for this information.
Social prescribing team keep this up to date.

13. What are the results? Our Work in Focus: Care Navigation
Results 11 months 2016/17
21,621 signposts away from GP appointments.
92% accepted signposts.
97% of patients surveyed were happy to see the healthcare professional they were signposted to.
277 trained Care Navigators across Wakefield.
Feedback
“I'm happy as long as I get to see someone who is best suited to help me.”
“It frees up the GP to see someone more needy, you are able to see the best person to help you. Makes the system more efficient.”
“Yes. Saves GP time. Target the problem.”
Results
21,621 Signpost away from GP appointments
92% accepted signposts
97% of patients surveyed were happy to see the health care professional they were signposted to
277 Trained Care Navigators
New improved SystmOne template & signpost criteria
81.5% of patients feel it is appropriate for Receptionists to Care Navigate
Feedback
‘I'm happy as long as I get to see someone who is best suited to help me’
‘It frees up the GP to see someone more needy, you are able to see the best person to help you. Makes the system more efficient’
‘Yes. Saves GP time. Target the problem.’
‘Yes I do. Could put some peoples mind at rest. Can be stressful seeing a doctor’
‘Yes - helpful. GPs have got a lot on their plate.’
‘I think so. See someone who is the best person to see.’

14. Quarter 1 – 3 FY2016/17 Services / Clinicians
Count of Accepted Navigations
Nurse telephone triage
138
Health & Wellbeing Development 6
Blood pressure monitoring 9
Warfarin monitoring 4
CASH Clinic 79
Counselling service
Dental service
District nurse
202
Health care assistant
350
Health trainer
IAPT 1
Midwife 3
Minor ailments clinic
112
Nurse practitioner
2332
Optician 97
GP Pharmacist
11183
Community Pharmacy service
1387
Physio First
828
Practice nurse
235
Smoking cessation service 15
Social prescribing service
Social Services
Voluntary support service for carers 8
Unspecified
1169
Grand Total
18185
These are the numbers of navigations going out to services and clinicians in the Wakefield district

15. GP Time Saved Table Service / Clinicians GP Time Saved (In Minutes)
Nurse telephone triage 5
Health & Wellbeing Development Worker 10
Blood Pressure Monitoring
Warfarin monitoring
CASH Clinic
Counselling service
Dental Service
District Nurse
Health care assistant
Health Trainer
IAPT
Midwife
Minor ailments clinic
Nurse practitioner
Optician
Pharmacist in GP
7.5
Community Pharmacy Service
Physio First
Practice Nurse
Smoking Cessation Service
Social prescribing service
Social Services
Voluntary support service for carers
This is the amount of GP time saved we allocate to each signpost a receptionist makes. This was developed locally with GPs, details to follow.

16. GP Time Saved Pharmacist in GP Advanced Nurse Practitioner
Prescribing Support Services (PSS) study suggested that for every 100 minutes of pharmacist time, 75 minutes of GP time was saved.
Therefore, for every Pharmacist navigation we have accredited 7.5 minutes of GP time saved.
Advanced Nurse Practitioner
Nurse Practitioner can effectively deal with all GP problems with the exception of Fit notes and termination of pregnancy.
Some patients who are referred to Nurse Practitioner could potentially see a GP for 10 mins or 5 mins through telephone call.
Therefore, for every ANP navigation we have accredited 5 minutes of GP time saved.
Physio First
Patients would normally be seen by a GP for minor MSK problems.
Now they are seen in a longer consultation by the physiotherapist.
Very few patients are referred back to the GP after using Physio First.
Therefore, each Physio First navigation is 10 minutes of GP time saved.

17. GP Time Saved Community Pharmacy Service
Patient rings for minor illness, is then normally given a face to face assessment by a GP or NP.
Care Navigation directs them to a more appropriate resource.
Patients could potentially have come to see a GP for an eye problem.
Therefore, each above navigation is 10 minutes of GP time saved.
Optician
Through Care Navigation we are diverting patients to a more specialised clinician through the pears scheme.
This means they are seen within 48 hours by their regular optician, who provides acute eye care in the community.
Dentist
Patient's should not be seen for dental problems in GP practice, but they can present quite frequently.
If they had not been asked the nature of their problem, these patients could have seen a GP and their time would have been wasted.
Therefore each dental problem care navigation is 10 minutes of GP time saved.

18. Practice Worked Example
Care Navigation at a practice with a list size of 12,500 patients
In Q1 16/17 (1,861 signposts)
Annualised to 7,444 signposts per year = 976 GP hours saved
(based on the ‘GP Time Saved Table’)
Typical GP at this practice works 8 appointment sessions of 3 hours
24 GP Consultation Hours per week
24 x 46 working weeks = 1,104 GP Consultation hours per year
This Practice has 7 x WTE GPs
7 x 1,104 GP hours = Total of 7,245 GP hours per year
976 / 7,728 = 12.63% GP Consultation Hours Saved

19. The West Wakefield Model
Accredited Online Training for Receptionists
Virtual Support & E-Consultancy
Face to Face Consultancy

20. Timeline 3 Months ‘Go Live’ Stakeholder engagement
Task and Finish Group
Provider Engagement Event – Phase 1
‘Go Live’
Designing local model
Accredited Online Training For Receptionists
Evaluation & Rolling Programme
3 Months

21. Outline of Accredited Online Learning
Covers the following topics;
What is care navigation?
Understanding the role of the care navigator
Understanding how to undertake care navigation
Understanding other health professionals we can work with for effective care navigation
This is the contents of our online learning package, which will take from 30 minutes to 2 hours to complete.

22. Essential Level Online Training Health Education England 2016
The Receptionists will be trained to the essential level via our online learning. They will not be expert at a social prescribing level for example.

23. Snapshot of Online Learning
©2016

24. Care Navigation Consultancy
Lessons learned from delivering this model in Wakefield & other elements of extending primary care
Multiple packages to suit differing requirements
Health Education England recommends face to face support to mentor learners so we are proud to offer this unique benefit.
Business Intelligence Support
Promoted by NHSE as best practice amongst the Vanguards
We facilitate the shared learning locally in terms of peer to peer support amongst experienced practice staff; secretaries, administrators practice managers often once worked on the reception booking appointments for patients. The practiced staff know the patients and are able to peer to peer support each other about what could work in practice. We facilitate the shared learning with guest speakers talking about phase one go live services, demonstration of locally developed clinical templates and our extensive experience of implementation through the hard earned lessons of implementing in Wakefield. These type of events are sighted by HEE as a key factor for success in care navigation programmes.

25. Any Questions?