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