Discover Portal

Care Navigation

NIHR Signal ‘Care navigation’ is being widely adopted in primary care, but in varying ways

Published on 29 January 2020

doi: 10.3310/signal-000868

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.

Share your views on the research.

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).

Bibliography

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).

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).

Bibliography

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).

Current understanding and implementation of ‘care navigation’ across England: a cross-sectional study of NHS clinical commissioning groups

Published on 9 September 2019

Stephanie Tierney, Geoff Wong and Kamal R Mahtani

British Journal of General Practice , 2019

Background Care navigation is an avenue to link patients to activities or organisations that can help address non-medical needs affecting health and wellbeing. An understanding of how care navigation is being implemented across primary care is lacking. Aim To determine how ‘care navigation’ is interpreted and currently implemented by clinical commissioning groups (CCGs). Design and setting A cross-sectional study involving CCGs in England. Method A questionnaire was sent to all CCGs inviting them to comment on who provided care navigation, the type of patients for whom care navigation was provided, how individuals were referred, and whether services were being evaluated. Responses were summarised using descriptive statistics. Results The authors received usable responses from 83% of CCGs (n = 162), and of these >90% (n = 147) had some form of care navigation running in their area. A total of 75 different titles were used to describe the role. Most services were open to all adult patients, though particular groups may have been targeted; for example, people who are older and those with long-term conditions. Referrals tended to be made by a professional, or people were identified by a receptionist when they presented to a surgery. Evaluation of care navigation services was limited. Conclusion There is a policy steer to engaging patients in social prescribing, using some form of care navigator to help with this. Results from this study highlight that, although this type of role is being provided, its implementation is heterogeneous. This could make comparison and the pooling of data on care navigation difficult. It may also leave patients unsure about what care navigation is about and how it could help them.

Expert commentary

It is noteworthy that over 90% of CCGs have some form of care navigation running in their area. It is rational to believe that care navigation should work and there is some reasonable evidence to show that it does work. The level of impact may be considered disappointing.

The amount of resources devoted to care navigation, as shown in this study, means that it is important for further research to identify how to design care navigation to maximise its impact.

Dr Peter Elton, Clinical Director, Greater Manchester and Eastern Cheshire Strategic Clinical Network

The commentator declares no conflicting interests

Author commentary

By 2023/24, NHS England estimates at least 900,000 people will access social prescribing. Care navigators will be critical to this, spending time with patients and connecting them to community resources.

This study highlights variability in how the role is currently being implemented in England. Notably, there is inconsistency in the terminology used to describe the role (for example, ‘link workers’, ‘care navigators’, ‘community connectors’).

As part of the NHS five-year framework for GP contract reform, social prescribing care navigators will become more common. However, care must be taken to ensure clarity and consistency in the way the role and remit of these workers are presented to patients to maximise their reach and impact.

Dr Kamal R Mahtani, GP and Associate Professor, Oxford Social Prescribing Research Network, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford