Clinical Governance

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The Signposting Toolkit includes a structured clinical governance framework to ensure all symptom instructions used by reception and care-navigation teams are safe, accurate, and up to date.

The aim is simple: to support consistent, defensible decision-making, while ensuring that the content used by non-clinical staff is clinically validated.

This governance model has been designed with NHS primary care standards in mind and can be overseen by a GP practice, a multi-site organisation, or a PCN.

Why governance matters

Reception and care-navigation teams handle a large volume of patient contacts every day. They must quickly decide:

• whether something is high-risk

• whether a patient requires urgent assessment

• whether symptoms can be managed by an alternative service

• which clinician or appointment type is most appropriate

The toolkit provides clarity, but clarity must be correct. Clinical oversight ensures that all information:

• aligns with local processes

• reflects current best practice

• is safe for non-clinical staff to use

• avoids accidental propagation of outdated guidance

Governance responsibilities

Each organisation using the toolkit should identify the following roles:

Clinical Lead (GP, ANP, or Pharmacist)

Responsible for:

• reviewing and approving symptom instructions

• validating high-risk flags and highlighted phrases

• ensuring local pathways are correctly represented

• periodic review of existing content

• signing off major updates and AI-generated changes

Surgery / PCN Admin Lead

Responsible for:

• creating or editing symptoms

• drafting updates and amendments

• managing local overrides

• ensuring reception feedback is incorporated

• coordinating review cycles with the Clinical Lead

Reception & Care-Navigation Team

Responsible for:

• using approved guidance

• highlighting unclear, outdated, or missing instructions

• reporting high-risk patterns or common points of confusion

Governance workflow

All symptom instructions move through three clear states:

1. Draft

• Created by Admin or Clinical Lead

• Visible only to Admins and reviewers

• Not shown to reception teams

• Can include AI-generated content (before review)

2. Submitted for Review

• Indicates the symptom is ready for clinical validation

• Clinical Lead reviews the wording, safety cues, and accuracy

• Can request changes or send back to Draft

3. Approved

• Fully validated content

• Visible to reception and care-navigation staff

• Locked from public editing unless changes are explicitly made

• Forms part of the organisation’s formal governance record

Approved symptoms represent the current, safe, clinically-endorsed guidance for frontline signposting decisions.

Using AI safely

The toolkit includes AI tools to improve clarity — not to generate clinical advice.

All AI assistance:

• rewrites staff instructions for clarity

• cannot publish directly to the live library

• must be reviewed and approved by a Clinical Lead

This ensures AI output supports readability without bypassing clinical oversight.

⚠️ **AI content is never published automatically.

Clinical review is mandatory.**

Customisation and local variation

Practices and PCNs differ in:

• available clinicians

• preferred pathways

• access to local services

• configurations for children vs adults

• appointment types

• safeguarding and escalation policies

The system allows each organisation to create local overrides that:

• adapt base symptoms

• add local rules

• adjust high-risk wording

• reflect local skill-mix and availability

This ensures the live symptom library always reflects how your practice actually works.

Periodic review

To maintain accuracy, organisations should review their symptom library at least annually, and more often when:

• local pathways change

• workforce or skill-mix shifts

• NICE or NHS England guidance is updated

• feedback from reception indicates confusion or ambiguity

The toolkit supports this by allowing:

• filtering by last review date

• tracking previously approved changes

• quickly identifying symptoms pending review

Governance in multi-surgery or PCN environments

The Signposting Toolkit supports shared governance across:

• federated practices

• multi-site surgeries

• PCNs with centralised triage or care navigation

Options include:

• each surgery having its own Clinical Lead and Admin team

• a PCN-level governance group approving base content

• shared symptom sets with local variation

This flexibility ensures governance scales with organisational structure.

Summary

The governance model ensures that:

• staff use consistent, safe, clinically validated instructions

• high-risk cues and escalation points are clearly highlighted

• local workflows and services are accurately reflected

• AI suggestions are always reviewed by a clinician

• organisations maintain a clear audit trail of changes

By combining robust governance with clarity for frontline teams, the Signposting Toolkit strengthens patient safety while reducing variation in signposting decisions.