Agenda item

The Committee received a report and presentation from the Director of Primary Care, Partnerships and Engagement, North Durham and Durham Dales, Easington and Sedgefield Clinical Commissioning Groups regarding Primary Care Navigation (for copy see file of Minutes).

The presentation highlighted the following points:-

·         Why do Care Navigation

·         What is Care Navigation

·         Benefits of Using Care Navigation

·         What Care Navigation is not

·         How Care Navigation works

·         Key stages in development

The Director of Primary Care advised that this process would enhance some skills that receptionists already had and for them to be recognised and utilised.  A pilot programme had been proposed, however due to the enthusiasm expressed it was going to be rolled out to all 500 GP receptionists in the County.  He made of point that patients would still have the power and choice and they could refuse the option of care navigation.  Some of the staff had met with GPS and practice staff in South Tees who had already implemented this system and they were very pleased with the results.  AAP feedback had been very positive and had been influencial in helping to shape the product.

The Director of Primary Care introduced Feisal Jassat, a lay member on both CCGs, who had been very supportive in the implementation.

Mr Hassoon was concerned that not every member of staff had been appraised of the changes as she was still experiencing problems at her own surgery.

The Head of Service (Primary Care) DDES CCG advised that there would be online, physical and soft skills training for all staff and this would be rolled out.   The Director of Primary Care said that he would be happy to take up any individual concerns.

Councillor Chaplow queried if it would be more appropriate to train the receptionists as health care assistants.  The Director of Primary Care replied that some receptionists did try alternative career paths but that this programme was not designed to turn them into health care professionals.  It was designed as a signposting tool however it could be a stepping stone for receptionists.

Councillor Grant expressed concerns about confidentiality as so many practices were open plan and people’s conversations could easily be heard.  She felt that this needed to be addressed so that it would not put people off using the system.  The Head of Service (Primary Care) advised that they were working with individual practices to address that.  They would be suggesting that a senior partner or GP from the practice use a voicemail to inform people about the care navigation practice when telephoning the surgery.  She added that in Wakefield they used a red card system whereby a patient could point to that if they wanted to have a confidential conversation.  She welcomed any suggestions from members as they were still in the development phase.

Adding to the issue of the reception areas, Councillor Grant said that the space between the receptionists and the waiting area needed to be sufficient so that people could not hear conversations as this was embarrassing to all parties.  She also suggested that background noise was used to distract what was being said at the reception desk.

Councillor Crathorne asked what qualifications the care navigators would have and Councillor Patterson agreed that this was as concern as they could be directing patients away from seeing a GP.  She was shocked to see this programme being rolled out across the County as would have expected it to have been carried out on a trial basis, with lessons learnt.

The Director of Primary Care explained that this was a mandatory national piece of work, covered in NHS England’s five year forward view for Gernal Practice.  Money would come centrally to support care navigation.  The initiative supported a pilot scheme in Wakefield two years ago and the evaluation of that model had been successful.  Wakefield had been approached by a number of CCGs to help them implement the programme.  All liability would rest with the GPs and they needed to ensure they felt safe with it.  He added that the attitude of receptionists were dealt with by the individual practice but that it was important that they dealt with all patients in a professional manner.

Councillor Bell said that he could see this working in a big urban community but that in small rural communities there was nowhere to be able to have those private conversations required.  In smaller communities most people knew each other and this could cause problems without any physical alterations to the buildings.

Referring again to the issue of confidentiality, Councillor Huntington said that a doctors reception felt like a hotel reception and people could hear most conversations.  She also felt that even when complaints were made about awkward receptionists nothing was done to address them.

On a more positive note, Councillor Quinn added that she had never heard any conversations at her own surgery.

The Chairman asked how the public were going to be assured about receptionists and why would a record of you saying no to the care navigator system be recorded.

The Director of Primary Care said that they had a brilliant receptionist workforce and that there always tended to be a focus on when things didn’t go well.  They were often put in a difficult position by the GPs they worked for.  Each practice had an obligation to ensure confidentiality and it was suggested that telephone areas were kept separate from the main reception. He added that unfortunately GPs were left with the buildings they had and these were regulated by the CQC.

Councillor Patterson asked that a consultation was carried out to ask patients for their views before implementation.  The Chairman reiterated the point that this was a compulsory function imposed on the CCGs.  The Director of Primary Care added that this was not seen as a substantial variation and that the choice would remain with the patient.

The Head of Service (Primary Care) explained that they were working with Healthwatch to carry out an independent evaluation to find out the public perception.  Once this system was set up and running in Wakefield, the patients there preferred it.  She said that they would be collecting data on how many people accepted care navigation and how many declined it so that could gain a greater understanding.  The GP would not interrogate a patient if they had declined the system but may point out that they could have received treatment elsewhere.

In conclusion, the Principal Overview and Scrutiny Officer said that he would respond formally in writing to the CCG on the Committees setting out the comments and concerns raised by the Committee.

Resolved:

(i)            That the report and presentation be received.

(ii)          That the comments and concerns raised by the Committee be forwarded to DDES CCG.