‘Dotmocratically’ designing care navigation


It’s 4.20pm on a Wednesday and the last couple of care navigators ‘in-training’ have just left the room. West Wakefield care navigation programme manager, David Cowan collects in the flip chart paper and pens after yet another hugely successful care navigation consultancy session.

“It’s so rewarding to see people’s opinions change throughout the course of the day,” smiles David who has been busy delivering the UK’s only accredited care navigation training programme for CCGs and practices. Designed entirely within general practice, for general practice, West Wakefield’s unique approach to active signposting is already benefitting patients and reducing GP pressures where it’s been introduced.

David Cowan - Care Navigation Programme Manager, West Wakefield Health & Wellbeing

So what makes it so different? David explains: “Succeeding at care navigation isn’t down to the CCG or the practice managers. It’s down to everyone. From local authority colleagues and the voluntary community sector, right across to the receptionists and GP clinical leads, everyone has to be involved from the start to make a real impact.”

The part of the consultancy session which focuses on designing their local service always starts the same way: “We ask everyone in the room to go through a mapping exercise to brainstorm all of the services they can think of which they could care navigate to. This can include services which are in pilot stage or are not able to be care navigated to just yet for example where a self referral pathway isn’t in place.

For patients, a self referral pathway is essential as a receptionist can’t take too long to complete a referral form during busy times in the mornings when surgery has just opened and the phone lines are under most pressure. This part of the session always starts up positive actions between commissioners and providers who start to look at ways they want to improve the pathways right there and then.”

Tackling some of these important barriers early on is crucial especially for long-established practice teams who may already have their own ways of doing things. David continues: “Practice teams know their patients and communities closer than anyone so who better to be at the forefront of any new local model? After the first half hour and a cup of tea, you start to see the possibilities flicker in people’s eyes as they start to realise just how much care navigation can improve patient choice, empower patients to choose well and free up GP appointments effectively.”

One of the most powerful parts of the training involves the voluntary community sector taking a lead. “GPs and receptionists often bring up the issue of social prescribing and how in many areas, only GPs can refer in to these services. Through the workshop, we help to change the perception on this and look at easy ways to improve the pathways.”

As David packs the last of his training materials away, he spots a lone box of colourful sticky dots on the far table: “Nearly forgot the most important box there,” he laughs. “We use these throughout the session to vote on the tricky bits as a group.

Questions such as what we think a patient would most likely accept as an alternative to a GP appointment, what a receptionist would feel most comfortable signposting away from a GP appointment and what would release the most GP capacity, all in the early stages of implementation to begin with. Everyone votes and the top six services to start with are selected. Dotmocracy at its best!”

If you would like to find out more about West Wakefield’s unique approach to care navigation and active signposting, get in touch today at carenavigation@westwakefield.org.uk.