Dementia Friendly Practices in Thames Valley – Learning & Opportunities Review & Resources
Pilot developed in partnership with:
Principles - SPACE
Image: http://wessexahsn.org.uk/img/projects/Dementia%20Friendly%20Surgeries%20brochure.pdf
• When considering supporting excellent dementia care in whichever environment, these 5 principles – known as SPACE need to be in place
• A commitment to these principles are crucial for a team, organisation, or site to consider and plan patient-centred care to deliver for patients and their carers
The Aim: To support the creation of exemplar GP practices in Thames Valley
• In November 2014, TV SCN and Health Education England launched a joint scheme inviting local GP Practices to bid for funding which would support them to become ‘dementia friendly’.
• Using the King’s Fund Health Centre Assessment tool in the evaluation of the bids, TV SCN awarded three practices as part of the scheme;
• These practices aimed to improve the physical environment of the practice, staff awareness and training and their own management processes to ensure patient and carers receive the care and attention they require when visiting the practice
Image reproduced by Flickr user - http://bit.ly/29qtF3A under Creative Commons - http://bit.ly/29rePKm http://bit.ly/1rMF155
• Bedford Street Surgery, Milton Keynes
• John Hampden Surgery, Prestwood
• Trinity Health Centre, Long Crendon, Aylesbury
with a further award to;
• Sheet Street Surgery, Windsor
Staff Awareness, Knowledge & Understanding
Key Focus: Raise awareness and build confidence in staff when dealing with dementia
• All staff and patient participation groups received Tier 1 and more specific Tier 2 Dementia Training (provided by Health Education England Thames Valley Dementia Academic Action Group) to learn about what is it like to live with Dementia and recognise and assist patients and carers in accessing support and services
• New roles were created in practices to create a supportive culture operationally (“Dementia Guardians” – looking out for patients when visiting the site) and strategically (“Dementia Champions” – embedding the principles)
• Practices engaged with other clinical staff from across the local NHS system including Older People Mental Health Consultants and Memory clinics to review pathways and share knowledge.
Partnership Working
As a community
Ensure post-diagnostic services (such as Prevention Matters in Buckinghamshire) are signposted
Consider working with local support groups, churches, local authorities and charities to create “communities of interest”
Practices joining the “Safe Place” scheme for those may also provide a further level of engagement and support to the community
Work with these groups to consider supporting activities such as “Singing for the brain” and other artistic activities
Key Focus: Involvement of varied stakeholders not only for patients, but carers and wider communities’ benefit
Patients and carers have; • Been engaged in their journey through the “This is
Me” resource • Been supported to create collaborative advanced
person-centred care plans • Been encouraged to discuss
End of Life care plans including Lasting Power of Attorney
The community have;
• Been aligned to ensure post-diagnostic services (e.g. “Prevention Matters” in Bucks) are signposted
• Worked with local support groups, churches, local authorities and charities to create “communities of
interest” • Considered practices joining a “Safe Place” scheme to
strengthen community support • Worked with local groups to support artistic
activities such as “Singing for the brain”
Clinicians in the practices have; • Created Multidisciplinary Teams – including social care, community practice workers, pharmacy,
community psychiatric and palliative care nurses to discuss and plan patient care • Developed Dementia Support Nurse capacity through training • Strengthened Named GPs and Support worker involvement throughout a patient’s condition • Engaged pharmacy to undertake medicine management audits (particularly anti-psychotics), safe
medication usage, dosette boxes, compliance etc
Patient Carer
Family
Process Improvements
Key Focus: Simple process changes in GP practice, to yield a more systematic approach to supporting those with Dementia
Practice Leadership – Create a culture of “No stigma” around Dementia
Proactive Patient information • Leaflets • Waiting room
Screens
Assessment • Systematic
use of “This is Me”
• Home visits if appropriate
• Referral to specialist support
Coding of patients to unlock the support they need
Use of agreed codes; • Dementia in
Alzheimer’s disease
Eu00
• atypical or mixed type (mixed
Dementia) Eu002
• Vascular Dementia
Eu01 or
• Unspecified
Dementia EU02z
System cleanse to ensure all codes such as; • h/o dementia,
cognitive decline • mild memory
disturbance, • memory
impairment
are checked and converted to the most appropriate code once a formal diagnosis is made
Create Alerts Once coding is complete, set Dementia Alerts on patient records
Changes to Appointment System
• Double appointments to allow patient and carer enough time
• Proactive follow up of Did Not Attend (DNA) appointments
• Memory prompts for appointment reminders – either via carer, telephone or text
Carers Support
Key Focus: To acknowledge and holistically support Carers’ efforts , their health and the role they play in Dementia care
Carer
Pilot Practices reviewed their care and support to ensure;
Carers are identified and written to, encouraging
engagement and offer of support
Carers included in all patient correspondence (consideration needs to
include hospital and other interactions - with consent)
Carers are offered a
physical “health check” (blood pressure, weight, depression screening, smoking, diet and alcohol support)
Carers are offered an
emotional “health check” – to
offer a level of support through regular review, referrals to CBT and
specific CBT for carers and carers break funding (if applicable)
Practical advice for Carers is
incorporated in support sessions e.g. Carers’ Register, grants, sitting services, access to
non-pharmalogical aides)
Information and signposting is
available (e.g. Alzheimer's Society resources)
Active links with local Carers support charities, support groups and local
authority advice and guidance – information can be accessed via the Carers Trust
Dementia-Friendly Environments – Trinity Health, John Hampden & Bedford Street
Key Focus – To enhance the physical environment
Practices implemented;
aesthetic changes to create a less confusing environment (plain coloured walls/contrasting frames and skirting
improved visual signage and installed dementia friendly clocks to simplify and aid orientation
music systems in waiting rooms
a “sensory garden” concept and design, after consultation with patients and carers
Power of Attorney Oct-13 2 Apr-14 4 Oct-14 21 Apr-15 25
Oct-14 44 Apr-15 25 Oct-15 44
Apr-16 46 DNACPR in place
Apr-14 5 Oct-14 36
May-15 31 Sep-15 33 Apr-16 33
Patients Admitted Sep 13-Mar 14 6 Apr 14 - Oct 14 15
Nov 14 - Apr 15 10 May 15 - Oct 15 12 Nov 15 - Apr 16 16
“This is me” Oct-14 15 Dec-14 25
May-15 36 Jun-15 39 Jul-15 41
Jan-16 51 Dementia Diagnosis
Apr-12 50 Apr-13 60 Apr-14 86 Oct-14 105 Apr-16 112
KPI Target (Q4) Q1 Q2 Q3 Q4
Dementia Friends 100% 100% 100% 100% 100%
Dementia Awareness;
staff to be Tier 1
trained
90% 71% 71% 71% 92%
Named GP for each
patient with
Dementia
100% 100% 100% 100% 100%
Patients to complete
a This is Me
document
85% 12% 32% 56% 64%
Identified Prevalence 67% 48% 60% 68% 68%
Annual Review
(including
medication)
95% 28% 64% 83% 96%
Next of Kin recoded
on Records 100% 40% 96% 96% 96%
Dementia Care Plan
shared on Summary
Care Record
100% 20% 48% 100% 100%
Results from John Hampden Surgery (Thames Valley) Dementia Friendly KPI’s - March 15- March 16
N.B. number of patients - with a list size of approx 11,000
Results observed from Best Practice Site (Not Thames Valley - Oakley & Overton Partnership, Hampshire) Sept 2013 – April 2016
Pilot Outcomes & Impact
Resources
Kings Fund Assessment tool – Health settings
Information on Merton Dementia Hub
Dementia diagnosis and management A brief pragmatic resource for general practitioners
“This is me” – personalised preference tool to help professionals understand individual needs
Infographic – Aims & Objectives of John Hampden Surgery project
Implementing Dementia Friendly GP Surgeries – Wessex AHSN
Health Education England – Training resources provided by the TV Dementia Academic Action Group (DAAG)
Alzheimer’s Society Resources
Dying Matters – End of Life information
Support for community engagement and partnerships in Dementia
Help and advice for Carers
Customer-facing Staff Handbook on how to help people with Dementia
“I am passionate about identifying our patients with dementia. Being diagnosed in a timely way will enable patients to access the right treatments and find the best source of support, as well as being able to make decisions about the future. In doing so, patients can “live well” with dementia and maintain a good quality of life” Dr Sian Roberts – John Hampden Surgery
This work has been delivered in partnership between Thames Valley Strategic Clinical Network and Health Education England – Thames Valley Our thanks go to all staff and patients at the participating practices; • Bedford Street Surgery, Milton Keynes • John Hampden Surgery, Prestwood • Trinity Health Centre, Long Crendon, Aylesbury • Sheet Street Surgery, Windsor
And also to Dr Nicola Decker – North Hampshire CCG Clinical Lead, Dementia for her Dementia Friendly Practice work and for sharing the excellent results achieved at Oakley & Overton Partnership