Health and social care navigators in general practice: towards an implementation framework

Introduction: Care navigation in general practice aims to connect patients to health, social and community services. The initiative seeks to support patients presenting with complex needs to gain access to ongoing care and support. This scoping review provides evidence-based guidance for introducing care navigators into general practice.

 

Methods: The review methodology follows the recommendations outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Five databases - Medline (Ovid), CINAHL (EBSCO), Embase (Ovid), PsycINFO (Ovid) and Scopus (Elsevier) – were searched for articles published between 2019 and 2024 that met predefined inclusion and exclusion criteria. After screening, data extracted from included articles was summarized in narrative format. Findings were mapped to a recently developed framework for implementation and evaluation of care navigation in primary care.

 

Results: From 1050 references retrieved from database searches, 32 articles were included in the review. Fourteen grey literature resources were also included. Over two-thirds of articles were from the United Kingdom, and just under two-thirds used qualitative methods. Key considerations for the effective introduction of care navigation into general practice were identified including planning; workforce availability, skills and training; general practice readiness for change; and flexible organisational processes.

 

External factors included buy-in from the voluntary, community and social enterprises sector and appropriate governance, funding and reporting. The review findings were mapped to the context-mechanism-outcome framework proposed by Calderon-Larranaga and colleagues (2024), resulting in meaningful groupings of causal elements across four contexts: individual characteristics of the care navigators; interpersonal relationships required of the care navigator role; a range of organizational contingencies, such as practice readiness for change; and an enabling policy context including flexible funding arrangements.

 

The review found that these four elements appear inter-dependent of each other within and between general practice, care navigators and the voluntary and community sector. This implies that if one implementation context is neglected, this can negatively impact care navigation in relation to one or more settings. For example, general practice can become siloed rather than networked; care navigators can operate in a transactional rather than a relational way; and the voluntary and community care sector can become non-redistributive, that is, be least accessible where their services are needed most.

 

Conclusion: This scoping review builds on existing work examining the implementation of care navigation in general practice. In testing a new framework using data from recent primary studies, the review findings support the coherence of using such a framework in identifying the core issues to consider when developing implementation mechanisms for care navigation at different levels. In so doing, the review provides an additional level of granularity which may be useful to the future design, implementation and evaluation of care navigation programs in general practice.

This research was commissioned by IFIC Australia and included consultation with Health Consumers NSW.