Can care navigation help us improve access to social prescribing?
Regional Lead for Northeast & Yorkshire, David Cowan, puts forward the case for first contact referrals to link workers
It will come as no surprise to those working in primary care networks, that demand for appointments is increasing and the number of GPs is dwindling.
GP Online reported in 2019 that over the four years to September 2019, the GP workforce grew by 1.3%. However, they go on to say that this figure includes registrars, and the rising number of GP trainees over the period conceals a 3.7% drop in fully qualified GPs.
According to the recent data May 2023 (latest data) we now have the equivalent of 2,165 fewer fully qualified full-time GPs compared to the September 2015 baseline (when the current collection method began) (BMA, 2023).
There is also a growing number of patients to treat, with the population of the UK estimated at 66 million mid-2017, its largest ever. The projected population surpasses 70 million in 2029 (ONS, 2017).
The increasing population combined with the decline in the number of GPs has – in some cases - resulted in overwhelmed GP surgeries, relied on for more than just healthcare. A report by Citizens Advice suggested that almost a fifth of GP appointment time is used for primarily social rather than medical problems.
Social prescribing helps reduce pressure on health and care services by supporting patients to access community based non-clinical services. However, many of these patients need to see a GP first, which uses up a clinical appointment for a non-medical need and requires two appointments for the patient, not one.
Relying on a first come first served GP appointment for access to a link worker can be frustrating for those navigating the system and those working within it. Patients have described trying to get an appointment as ‘confusing’, ‘frustrating’, ‘worrying’ and ‘unfair’, whilst staff have reported problems prioritising referrals, dealing with higher volumes of complex needs and an increase in demand for appointments.
The new 2023/4 GP contract could help address this problem. It stipulates patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice.
70% of Primary Care Network (PCN) funding is now paid out to PCNs automatically monthly. The remaining 30% will go on access. This presents an opportunity for social prescribing teams to work with reception and through care navigation, improving access to social prescribing as long as demand is matched by capacity.
The NHS delivery plan for recovering access to primary care, lays out a plan for PCNs looking to do this and I have witnessed its benefits first hand.
Through my role at the General Practice Improvement Programme at NHS England, I have had the pleasure of working with Tracy Burton, the practice manager at Newsome Surgery in Huddersfield, Northeast and Yorkshire region. A script was developed to help staff manage inappropriate appointment requests. For example, ‘A social prescriber would be able to help you better than a GP.’ Staff were trained on the new care navigation process and tested it over several weeks, applying continuously quality improvement methods.
By implementing this model, Tracy and her team have freed up approximately 60 GP appointments per week. These appointments are being used by GPs to see the patients who need their care and to book follow-ups within the two to three weeks required.
Referrals to the Kirklees social prescribing service have increased by 10%. The social prescribing service has become so popular the practice is now looking to hold group sessions around key themes like healthy eating and budgeting. Before care navigation most GP appointments were gone by 09:30am whereas now some are still available after 11:00am.
Social prescribing link workers often work with high caseloads, but in some instances, can be underutilised. Each issue requires a coordinated response. By ensuring any increase in referrals to social prescribing through care navigation are manageable, we can support PCNs with improved access for patients with social prescribing needs.
