In Episode 62 of the General Practice podcast (here) Nick Sharples explained Active Signposting; a system of non-medical telephone triage. In this guest blog Nick describes the six keys to successful implementation.

With the GP Forward View strategy now well established, many CCGs, GP Federations and individual Practices are seeking to commission training in the two High Impact Actions (HIA), for which NHS England has provided ring-fenced funding.

Active Signposting is one of these and has the potential to save up to 26% of GP consultation time if fully and effectively implemented. But how do you introduce Active Signposting in such a way that the potential savings are optimised? And what do you need to consider when commissioning such activity?

Here at DNA Insight we have identified six key elements of success:

1. Preparation is Vital

Introducing Active Signposting brings a change to the way in which the Practice currently operates, and it will affect the entire Practice Community, albeit for the better. It is not just the training of the reception team that is important – but how the system is introduced to the whole team.

You or your training provider should consider:

• The need, scope and creation of a Service Directory (start small and build over time)
• The building of an EMIS or SystmOne template to allow signposts to be recorded and exported for analysis
• The need for Red Flag Protocols to be articulated, written down and available to Receptionists
• The need for the GPs or the Federation/CCG to decide which of the available alternative services (in-Practice or outside in the community) offer the most potential for early Signposting wins. These services should be amongst the first to be introduced but will almost certainly need some additional consultation to ensure they are ready for the increased flow of patients. (Where available, Pharmacy and MSK/Physio related services top the charts for delivering the greatest numbers of signposting opportunities.)

All of these activities can be developed concurrently while you are going through the procurement process for a training provider, but ideally, they should all be in place before the training of your Reception team starts. In that way, your Receptionists can train on scenarios that will be immediately relevant when the Signposting starts.

2. Engage the Whole Practice Community

Active Signposting will not happen just because you’ve been on a course. GPs, Practice Managers, Clinical staff and external service providers such as Pharmacists and Physiotherapists all need to be engaged in the programme for the benefits to be realised.

The training programme offered by your provider should be bespoke to your specific needs. They should take time to understand the local dynamics of the Practice and the wider Federation or CCG within which it operates – customising the training accordingly, so that it is both relevant and valuable.

3. Face to Face or Online?

Whilst some training works well when delivered remotely, in Active Signposting it is the face-to-face practice and the interaction with colleagues that goes a long way to making sure the techniques will be adopted on return to the Practice.

Trying out new techniques in a safe training environment, with a colleague on the end of the phone playing the role of the patient, provides the necessary self-confidence for Receptionists to introduce the techniques when they finish the training.

4. Bring Everyone to the Training

Encourage your commissioners, Practice Managers and GPs to attend the training, alongside the Reception team. Such high level attendance not only empowers the Receptionists with the authority to apply the techniques they are taught, it also exposes managers and GPs to the realities of life behind the Reception desk.

If training budget is an issue, consider running a pilot with a complete practice team or several. This is far preferable to trying to spread the knowledge across the organisation by training a couple of Receptionists from each Practice, and then hoping that they will magically be able to train their colleagues when they get back. Whilst nice in principle, it almost never works in practice.

5. Promote the Service to your Patient Community

Active Signposting is a Win-Win for all members of the Practice community, and the patients are no exception. Making them aware of the introduction of Active Signposting/Care Navigation will encourage them to share their symptoms with the Receptionists, which will allow a signpost to be offered.

One of the most effective ways to do this is for the senior GP to record a message on the front end of the Practice phone system encouraging patients to share their symptoms with the reception staff.

6. Have a Formal Go Live Date

It’s not unusual in our experience for the training of the Reception team, and the separate but necessary preparation of the Service Directory, Data Collection template and consultations with chosen service providers, to get out of sync.

It is important however that all are in place prior to your ‘Go Live’ day. As the saying goes, “You never get a second chance to make a first impression”. With so many stakeholders involved and affected by the change, getting it right first time is essential.

DNA Insight provides support and training to GP Practices in Active Signposting, the Management of Medical Correspondence, Reducing Missed Appointments, and Quality Improvement & Leadership. These High Impact Actions are designed to transform General Practice as part of the NHS England’s GP Forward View strategy. Please contact us on 0800 978 8323, email info@dnainsight.co.uk or visit our website at www.dnainsight.co.uk.