The problem
In the UK it is estimated that around 850,000 people have dementia. Dementia has a huge impact on people living with the condition, their carers, families and society.
At John Hampden Surgery, we aimed to make our surgery dementia friendly, better identify our patients with dementia, and support them to live well.
We used the Royal College of Nursing SPACE principles (staff, partnership working, assessment and diagnosis, care planning, environment) and employed a dementia support nurse to support and co-ordinate care.
What we did
Our team has had a shared vision for this project, having been touched personally by dementia. We explored models trialled nationally and used examples of best practice to develop our own plan for the practice. The staff all received dementia awareness training as a team, which marked the start of the project in April 2015. Enthusiasm escalated as the year progressed, as each team member recognised the impact of their role within the team. The key has been around raising awareness and recognising the importance of dignity and compassion.
We had monthly staff meeting, planning how to become dementia friendly (for example with signage, name badges, dementia clock). All staff members became a dementia friend – someone who has completed dementia friends awareness training, learning what it’s like to live with dementia and turning that understanding into action (part of a large national initiative from Alzheimer’s Society). All staff also completed Tier 1 dementia awareness training provided by Health Education England Thames Valley.
Each member of staff became a ‘dementia guardian’, meaning they take responsibility for patients with dementia attending the surgery , which involves being more mindful they may need extra support to be comfortable and not agitated (and offer help if they are), help with orientation to clinics/toilets, ensure they are safe in going home, and give them written appointment cards. So each receptionist would assume this role for any patient with dementia who was in the surgery.
A receptionist volunteered to become a dementia champion and facilitated a ‘memory box’ with contributions for the box from each member of our team. This is a collection of pictures or items that act as a talking point, for example photos of the Queen’s Coronation, steam engines, to help facilitate communication, which patients with dementia often find difficult.
Our dementia support nurse visits the patients at home, to offer support and signposting to relevant services as well as helping patients complete a ‘This is Me’ document – a patient centred approach to care planning that people with dementia can use to tell staff about their needs, preferences, likes, dislikes and interests. For instance they may not like getting up in the morning, so we would offer afternoon appointments, or they are avid gardeners, which can be used by staff to engage with the patient and make them feel at ease.
Our Patient Participation Group supported the practice in holding dementia awareness stalls in our waiting room, with Carers Bucks, Alzheimer’s Society and other relevant organisations.
Challenges
We needed to allocate time to have meetings and make the plans and changes. We prioritised our protected practice learning time for the project. We needed funding for the environmental changes and for the dementia support nurse, which we got through a successful bid from Thames Valley Strategic Clinical Network.
Results
Our practice dementia prevalence increased from 48% to 68%, and all our staff are now dementia friends and all are Tier 1 trained in dementia awareness.
All patients with dementia have a ‘flag’ advising of diagnosis of dementia and the need for a double appointment. All of these patients had an annual care review and they were all offered a flu vaccination with 87% take up. 92% of patients have a completed care plan that is uploaded to shared care record (which out of hours, A&E and the ambulance service can see).
We now record carers or next of kin details in notes of patients with dementia – the number of patients with dementia with a carer or next of kin recorded increased from 30% to 92% by the end of the first year. 100% of carers have been offered a review with Carers Buckinghamshire and 65% have taken up this offer.
69% of patients have been offered the This Is Me template to complete. 35% of patients have so far completed one.
We have shared our learning with NHS Chiltern CCG, and as a result, all 34 practices within the CCG are now working towards becoming dementia friendly.
We were nominated as GP team of the year at the General Practice awards for this project.
Dr Sian Roberts is a GP in Prestwood, Buckinghamshire and is clinical director for NHS Chiltern CCG
