School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, Oxford Road, M13 9PL, Manchester, UK.
Sheffield Methods Institute, Interdisciplinary Centre of the Social Sciences, University of Sheffield, 219 Portobello, S1 4DP, Sheffield, UK.
BMC Prim Care. 2022 Apr 1;23(1):66. doi: 10.1186/s12875-022-01669-z.
A national policy focus in England to address general practice workforce issues has led to a commitment to employ significant numbers of non-general practitioner (GP) roles to redistribute workload. This paper focuses on two such roles: the care navigation (CN) and social prescribing link worker (SPLW) roles, which both aim to introduce 'active signposting' into primary care, to direct patients to the right professional/services at the right time and free up GP time. There is a lack of research exploring staff views of how these roles are being planned and operationalised into general practice and how signposting is being integrated into primary care.
The design uses in-depth qualitative methods to explore a wide range of stakeholder staff views. We generated a purposive sample of 34 respondents who took part in 17 semi-structured interviews and one focus group (service leads, role holders and host general practice staff). We analysed data using a Template Analysis approach.
Three key themes highlight the challenges of operationalising signposting into general practice: 1) role perception - signposting was made challenging by the way both roles were perceived by others (e.g. among the public, patients and general practice staff) and highlighted inherent tensions in the expressed aims of the policy of active signposting; 2) role preparedness - a lack of training meant that some receptionist staff felt unprepared to take on the CN role as expected and raised patient safety issues; for SPLW staff, training affected the consistency of service offer across an area; 3) integration and co-ordination of roles - a lack of planning and co-ordination across components of the health and care system challenged the success of integrating signposting into general practice.
This study provides new insights from staff stakeholder perspectives into the challenges of integrating signposting into general practice, and highlights key factors affecting the success of signposting in practice. Clarity of role purpose and remit (including resolving tensions inherent the dual aims of 'active signposting'), appropriate training and skill development for role holders and adequate communication and engagement between stakeholders/partnership working across services, are required to enable successful integration of signposting into general practice.
英格兰的一项国家政策重点是解决全科医生劳动力问题，因此承诺雇用大量非全科医生（GP）角色来重新分配工作量。本文重点介绍了这两个角色：护理导航员（CN）和社会处方联络工作者（SPLW），他们的目标都是在初级保健中引入“主动转介”，以便在适当的时间将患者引导至合适的专业人员/服务，从而释放全科医生的时间。目前缺乏研究来探索工作人员对这些角色如何被规划并纳入全科实践，以及转介如何被整合到初级保健中的看法。
该设计使用深入的定性方法来探索广泛的利益相关者工作人员的观点。我们生成了一个有目的的样本，包括 34 名受访者，他们参加了 17 次半结构化访谈和一次焦点小组（服务负责人、角色扮演者和接待全科医生）。我们使用模板分析方法分析数据。
三个关键主题突出了将转介纳入全科实践的挑战：1）角色认知——由于其他人（例如公众、患者和全科医生工作人员）对这两个角色的看法，转介变得具有挑战性，并且突出了积极转介政策的既定目标所固有的紧张关系；2）角色准备——缺乏培训意味着一些接待员工作人员觉得自己没有准备好按照预期承担 CN 角色，这引发了患者安全问题；对于 SPLW 工作人员来说，培训影响了整个地区服务提供的一致性；3）角色的整合和协调——卫生和保健系统各组成部分之间缺乏规划和协调，这对将转介成功纳入全科实践提出了挑战。
这项研究从工作人员利益相关者的角度提供了有关将转介纳入全科实践的挑战的新见解，并强调了影响实践中转介成功的关键因素。明确角色目的和职责（包括解决“主动转介”双重目标固有的紧张关系）、为角色扮演者提供适当的培训和技能发展，以及在服务之间进行充分的沟通和利益相关者参与/合作，这些都是将转介成功纳入全科实践所必需的。
