The evaluation of a Primary Care Navigator (PCN) programme based in South Lambeth and focused on providing support to people with diabetes and their carers across Lambeth.

The programme has been established by the National Association for Primary Care (NAPC) in partnership with Health Education South London (HESL). The Tavistock Institute for Human Relations (TIHR) was commissioned by the NAPC to support it in undertaking an evaluation of the programme.

The main aim of the evaluation is to understand how well PCNs are engaged, developed, maintained and supported in their role. The methods are framed by a Theory of Change approach, and include additional support for the analysis of PCN baseline and patient feedback data, supplementing this with case studies, interviews and desk research.

Context

Primary Care Navigation is part of a growing trend to connect patients who are lost in the care system with helpful services. This project was an evaluation of a Primary Care Navigator (PCN) programme based in South Lambeth and established by the National Association for Primary Care (NAPC) in partnership with Health Education South London (HESL). The programme focused on providing direction for people with diabetes and associated conditions to resources that could help them with their condition. The PCN (Diabetes) programme started in 2015 and 11 GP Practices and 10 pharmacies participated in the project, training a total of 41 navigators.

Objectives

• Understand how the PCN programme fit within Primary Care for people with diabetes in Lambeth, and;
• Identify the programme’s objectives, and understand how and why these objectives were achieved.

Methodology

The research combined three methods: document review, surveys, and qualitative research. First, the evaluation team collected documentary evidence and monitoring data in partnership with the NAPC, supplementing this with a literature review on care navigation. Second, pre- and post-surveys with PCNs and their supervisors were analysed alongside 236 patient surveys, filled in following PCN sessions. Third, qualitative data was collected primarily through short case studies of participating organisations and interviews with project steering group members.The data was synthesised and analysed using framework analysis, a matrix approach that allows for thematic analysis by case. The themes of the project included patient engagement, confidence of PCNs, supervisor relationship, training, and organisational culture.

Impact

The evaluation made several recommendations to the NAPC: 

1. Consider trialling supplementary arrangements for Primary Care navigation than the current model of training existing staff to navigate. Other models include full time staff who visit several sites and are able to dedicate more time to the navigation task.
2. Given the potential to use PCNs to target health inequalities, initial research and targeting of groups which are disproportionately affected by diabetes would help PCNs to target patients more effectively.
3. Review the processes by which patients take up PCN services to ensure take up by all those who can benefit from it.
4. Develop a database of PCN episodes to understand the contribution they are making to patient outcomes and GP surgery resource use.

Results

The evaluation found the programme had three kinds of impact on patients: 

1. Better patient engagement with care services
2. Improved self–management of their condition
3. Healthier lifestyles

Of these three outcomes, self-management and healthy lifestyles were seen to increase the most. This is partly explained by the PCNs’ emphasis on wellbeing, rather than ill-health and its promotion of a more holistic way of engaging patients.The evaluation found that the PCNs tended to struggle in a variety of ways depending on their organisational context: 

1. Managing patient expectations was difficult, particularly in clinical settings, where patients were sometimes upset to find the service was navigational rather than diagnostic.
2. In some areas recruiting patients was a continual challenge and required systematised relationships across the organisation to be most effective.
3. PCNs struggled to find time to complete their navigation role alongside their main tasks, particularly in understaffed locations and the individual capacity to cope with competing demands and negotiation with the organisation became important in many cases.
4. Finally, many supervisors were unconvinced that the PCN role was effective in preventing primary care admissions and reducing the burden in GP surgeries. Further impact research should build on the themes of this evaluation to measure the quantitative benefits of care navigation for the organisations involved.

In grappling with these challenges, almost every PCN increased their knowledge and confidence through the project, and improved links with other services, making the local diabetes care system more integrated through their actions.

Project Team

David Drabble Richard Allen‎ Hannah Walsh