Pharmacy, optometry and dentistry have publicly adopted the strategic direction, releasing their own responses aligning with A Healthier Wales. Pharmacists and optometrists are actively diversifying to offer more clinical services in primary care. Their provider contracts have changed to reflect and remunerate this change.
The GP surgeries we spoke to have adopted a process called ‘care navigation’. This is commonly carried out by practice receptionists. It involves gathering some basic details about the reason for a citizen contacting the practice so that they can be directed to the best option for their needs. This might be to encourage self-care where appropriate or redirection to other health care professionals (pharmacists, optometrists or dentists), emergency services, community care or non-clinical services.
This appeared to be most successful where practices were able to provide care navigation training for staff, alongside various tools to support the care-navigation process. Some practices felt that care navigation provided choice to citizens about the best option for them, achieving better outcomes for them in the process.
‘Telephone-first’ triage
The practices have also largely adopted a ‘telephone-first’ triage model. This is where the first contact with a practice clinician such as a GP is via a telephone call. This allows the clinician to speak to the citizen and establish whether they are best placed to handle their issue. If they are, many consultations are then carried out successfully over the phone. Only those that need to be seen face-to-face are invited into the practice.
This move to telephone triaging happened mostly as a response to the pandemic, for infection control reasons. However, a small number of practices we spoke to had moved to this way of working before the pandemic as a method for handling demand. Most practices have discovered they can do much more by phone than expected.
Interestingly, none of the GP surgeries we spoke to said that they were working this way because of the new Primary Care Model for Wales, but rather as a response to the pandemic and the challenges of managing demand.
Better outcomes
Our interviews with allied health professionals revealed that they have the skills and desire to be more heavily involved in public health and primary care. We heard they currently only work with citizens when an individual’s health has already deteriorated. They reported routinely encountering situations in which better outcomes could have been achieved had they been involved sooner.
They indicated that they would welcome being involved in prevention for at-risk groups or directly accessible within the community for those needing support. Some roles, such as physiotherapists, occupational therapists and paramedics, are already involved in multi-professional ways of working alongside general practice.
Our research with citizens found that some were already behaving in a proactive way that supports the future model of primary care. We heard (unprompted) how people were already proactively taking responsibility for their own health and care.
They described:
- doing their own form of triage, using knowledge of their own health and awareness of conditions associated with people of a similar age, gender or weight
- how they often visited a pharmacy first to avoid a GP appointment
- using monitoring devices (not always correctly), with and without direction from a GP
Care navigators
No citizens we spoke to objected to being redirected to other services in principle, but several reported issues when care navigators at their practices had insisted on redirecting them.
They felt this was inappropriate because the care navigators were not clinically qualified, and their actions were seen as overstepping their role. Several participants shared stories about inappropriate redirection and how their concerns were justified by events that followed.
Cost was also a concern where people are redirected from practices to opticians and dentists or choose to self-direct to one of these providers. This could prove a barrier to accessing healthcare for some.
One participant told us:
"Issues arise around cost – opticians will charge, but if you say you’ve been redirected by the doctor, then they don’t charge. The effect [if you don’t know this] is that you’ll go less frequently, and when things [health issues] are further advanced. Those things worry me."