The challenges of integrating ‘signposting’ into general practice: perceptions of staff involved in care navigation and social prescribing roles

Background: Care navigation and social prescribing link worker roles have been introduced into general practice as part of a wider effort to address GP shortages and the increasing challenge of providing care to an ageing and ailing population. Care navigation roles, usually undertaken by receptionists, aim to provide first point of contact to signpost patients to the most appropriate source of help which may free up GP time. National investment of £45 million was made available via clinical commissioning groups to train reception staff to incorporate care navigation into their existing roles. Social prescribing link worker roles aim to provide holistic, community-based support to patients through shared decision-making, care and support planning, utilising community and voluntary sector services. As a new role, it is as yet unregulated/unregistered and there is no clear role definition, with different models of social prescribing existing. The NHS long term plan commits to providing 1000 new social prescribing link workers in general practice by 2020/21 and 100% funding for the role is available to primary care networks via the Additional Roles Reimbursement Scheme from 2019. We explored the planning and integration of these new roles in one region of the UK to identify the operational issues faced in implementing these new roles to understand how issues were being addressed.
Methods: We report on interviews conducted with individuals involved in care navigation and social prescribing roles - respondents included service leads/role holders and host GP practice staff. Thirty three respondents (n=23 care navigation; n=10 social prescribing) took part in 18 semi-structured interviews (n=10 care navigation; n=8 social prescribing) and one focus group (n=13 care navigation) between April and July 2019. These data form part of a wider study exploring the integration of new roles into general practice. We analysed data using a thematic approach and employed inductive and deductive coding techniques.
Results: The theme linking the two roles is the challenge of ‘signposting’, with distinct and overlapping challenges faced by both roles in their integration into general practice. For care navigation, ‘signposting’ was problematic in three ways: 1. Patient and staff perception of the role led to challenging interactions with patients who resisted attempts to signpost away from GP appointments. 2. Receptionists’ perceived lack of preparedness for the role was highlighted as well as some feeling it to be an unsuitable role for non-clinicians. 3. A lack of planning and coordination across services impaired success; for example, some reported signposting patients to overloaded services that refused patients and this led to a lack of patient trust. For social prescribing, challenges experienced were threefold: 1. A perceived lack of role clarity in general practice led to them receiving inappropriate referrals. 2. Lack of preparedness/training was also a challenge. Given the relative newness of the role, social prescribing link workers came from different professional backgrounds; this led to concerns about providing consistency of offer across areas and led some leads to develop competency frameworks. 3. The sustainability of existing social prescribing schemes was questioned, following the introduction of the PCN employed link workers. This raised concerns that if the social prescribing link worker role became more primary care-based it may become more clinical in focus and less ‘holistic’ or person-centred. Concern was also expressed that the strong links built up with the community and voluntary sector over-time by existing social prescribing schemes could be lost.
Implications: Our study provides learning opportunities for implementation of new roles into general practice. We will discuss the need for communication and engagement between stakeholders, including clarity around role definition, specific training for role holders and robust measuring of impact of new roles.