Clinical Commissioning Groups (CCGs) in England are implementing care navigation in primary care to help people with non-medical issues to access alternative services. This ‘social prescribing’, facilitated by nominated care navigators, also aims to reduce the pressure on general practice, and forms part of the NHS Long Term Plan.
This NIHR-funded study shows that the role is fulfilled in different ways by people with a wide variety of job titles. This may make it harder for patients to understand what the role is and how it can help them. It may also make it more difficult to assess the impact of the service at the national level.
The use of care navigators needs careful evaluation to determine how they can be most effective, but only a third of CCGs have assessed or have plans to assess their impact.
Why was this study needed?
‘Care navigation’ describes the way in which people are supported to identify and use appropriate health and other services. These services are provided by different agencies and professionals, and this can cause confusion.
GPs are often people’s first point of call when non-medical issues are affecting their wellbeing and health, even though other services may be more appropriate. Care navigators, also known as link workers or social prescribers, can help signpost people to the relevant local groups and support services.
This model of helping people to navigate services is part of the move towards personalised care, detailed in the 2019 NHS Long Term Plan. It is already being implemented in many areas, but there has not yet been an assessment of exactly how this is being done, or the most effective approaches. This study explored how care navigation is being implemented by CCGs in England.
What did this study do?
This study was a cross-sectional survey of CCGs in England. Requests for information were sent out to all 195 CCGs in November and December 2018, and data collected up to the end of January 2019.
CCGs were asked about who provided care navigation, which types of patients were referred to care navigators and how, and whether this service was being evaluated. CCGs were able to respond with as much or as little information as they wished.
A total of 193 CCGs responded, but only 162 (83%) provided usable data. The responses were entered into Excel for analysis, with the researchers interpreting some of the open-ended responses as needed for analysis. They summarised their findings using descriptive statistics.
What did it find?
- In total, 147 CCGs (91% of those with useable data) reported that they provided some form of care navigation. Almost all of the remaining CCGs (14 out of 15) were in the process of developing a care navigation service.
- The people carrying out the care navigator role had 75 different titles, these titles even varied within individual CCGs. In 39% of CCGs, an existing member of practice staff provided the service, usually a receptionist with additional training. Almost a quarter (23%) reported that they recruited staff specifically to work in a dedicated care navigation service. The remainder used a mixture of existing practice staff, dedicated employees and volunteers.
- Most care navigation services were available to all adult patients. However, some CCGs provided the service only for specific patients, such as older or frail people, those with long-term conditions, or high users of the GP surgery.
- Most care navigation services had people referred to them by a community or primary care professional. Self-referrals were also common. People often accessed the service as part of their initial contact with their GP surgery when receptionists were acting as care navigators.
- Only 22% of the 147 CCGs reported that at least one of their care navigation services had been evaluated. A further 12% (18 CCGs) said that evaluations were planned or in process. Many CCGs said that their service hadn’t been running for long enough to have done any evaluation yet.
What does current guidance say on this issue?
There is no national guidance on implementing care navigation services. Health Education England has published a competency framework for care navigators, which outlines a core set of competencies for people carrying out the role. This provides a benchmark for care navigation.
NHS England has also produced a summary guide for social prescribing and community-based support. This is best-practice advice, aimed at those leading local implementation of social prescribing. It describes what good social prescribing looks like and what needs to be in place locally, as well as providing sample job descriptions.
What are the implications?
This study has highlighted a high level of implementation of care navigation services in primary care in England. However, care navigation is being interpreted and implemented differently across CCGs. This makes it more difficult to evaluate care navigation as a policy, with problems both comparing and pooling data.
The variability may be confusing for those referring patients and also the patients themselves – it may not be clear what care navigation is, where to access it, and how it could help them. Ensuring greater consistency could help to improve uptake of the service.
Citation and Funding
Tierney S, Wong G and Mahtani KR. Current understanding and implementation of ‘care navigation’ across England: a cross-sectional study of NHS clinical commissioning groups. Br J Gen Pract. 2019;69(687):e675-81.
This project did not receive specific funding, but all authors’ salaries are partly supported by the Evidence Synthesis Working Group of the NIHR School for Primary Care Research (project reference number 390).
Health Education England. Care navigation: a competency framework. London: Health Education England; 2016.
NHS. NHS Long Term Plan. London: Department of Health and Social Care; 2019.
NHS England. Social prescribing and community-based support: summary guide. Leeds: NHS England; 2019.
NHS England and NHS Improvement. Social prescribing link worker welcome pack. Leeds: NHS England; 2019.
NHS England and NHS Improvement. Social prescribing link workers: reference guide for primary care networks. Leeds: NHS England; July 2019.
Valaitis RK, Carter N, Lam A et al. Implementation and maintenance of patient navigation programs linking primary care with community-based health and social services: a scoping literature review. BMC Health Serv Res. 2017;17(116).
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