An increasing number of GP surgeries are becoming ‘dementia-friendly’ as part of a wider movement that aims to create communities better able to support patients with the condition.
To date, much of the focus on improving dementia patients’ experiences in the health service has been on the secondary care side. In 2012, for example, Dementia Action Alliance launched a call to action to create dementia-friendly hospitals. More than 100 have signed up to its charter.
However, primary care is now taking a more proactive approach. From this April, pharmacists are being financially incentivised to register with the Alzheimer’s Society Dementia Friends programme, a campaign that aims to tackle the stigma and lack of understanding about the condition.
GPs are also playing their part, aiming to hone the support and care provided at practice level. Dr Nicola Decker, clinical chair of the North Hampshire CCG and its dementia lead has developed a dementia-friendly primary care project that is being adopted in the Wessex LMC area of Dorset, Hampshire, the Isle of Wight, Somerset and Wiltshire.
Dr Decker says that being dementia-friendly is not about tick boxing, nor about financial incentives ‘it just makes sense’.
‘It’s about putting yourself in the shoes of a dementia patient and thinking what kind of support would you want or a close relative to have,’ she explains. ‘The good news is it doesn’t have to involve very expensive changes.’
Steps practices can take
So what steps can practices take to become dementia friendly?
The Alzheimer’s Society senior policy officer Andrew Boaden explained that the main challenges people with dementia face when seeing their GP is missing appointments, becoming confused or agitated at the surgery, struggling to recall details of discussions regarding their care and difficulty navigating their way round the surgery.
To address these, Dr Decker adapted a set of principles already used in hospitals to a primary care setting, naming it iSPACE.
It sets out six steps to becoming a dementia friendly practice:
- Identify one or two Dementia Champions in the practice
- Staff who are skilled and have time to care
- Partnership working with carers, family and friends and the voluntary sector
- Assessment and early identification of dementia
- Care plans that are person centred
- Environments that are dementia friendly
This approach was first piloted at her practice, the Oakley and Overton Partnership, in 2014, with funding support from the Wessex Academic Health Science Network.
Essentially, Dr Decker says, it’s a system that encourages a practice-wide approach and change in mindset and culture.
Now, when a dementia patient calls the surgery, a receptionist is immediately alerted by the computer system that the caller is someone with the condition. This means special processes can be put in place.
‘They are automatically given a double appointment, for example, because it’s important not to rush patients with dementia,’ says Dr Decker. ‘We also ensure they are a given the same GP for each appointment to ensure better continuity of care. And we know to send out a reminder to the patient attend the appointment.’
To address potential problems around communication the practice encourages the involvement of a carer or other person close to the patient.
‘We ask the patient to identify someone they would like to be included in any communication between the practice and themselves and ask for written consent for that to happen,’ says Dr Decker.
‘Consent is noted on patient records. It’s an important governance issue that gets around the question of confidentiality. It means carers or relatives are also informed about any appointments and invited to attend as well. It’s done in a respectful way and makes it easier for the patient who may have memory problems.’
Another key change was encouraging patients to complete an Alzheimers’ Society form called ‘This is me’, which records details about an individual such as their cultural background, preferences, and routine. It is a tool to support person-centred care in a hospital, care home or respite care setting.
‘We are trying to encourage patients to complete it when they are well so we can be one step ahead and be able to share with the hospital should they be admitted,’ Dr Decker says.
Making changes to the physical environment of a surgery is also important in supporting dementia patients.
Dyneley House Surgery, an eight-GP partner practice in Skipton, North Yorkshire, took the opportunity to become dementia-friendly in 2014 when planning a refurbishment of the patient waiting areas, explains practice manager, Antony Radley.
Using a King’s Fund evaluation tool as a guide, improvements included choosing solid colour carpets, contrasting wall colours and paintwork and displaying images of local places on the walls.
‘We understand that complex patterns can become confusing and images of local landmarks can offer a sense of familiarity,’ Mr Radley explains.
Signs are also dementia friendly so, for example, the toilet sign is an image rather than being a word. Even details such as the clock can be important.
‘Our’s has every hour marked rather just the quarter hours or it being completely numberless,’ says Mr Radley. ‘Some of the changes are small and inexpensive, but can make a big difference. It’s very achievable for practices.’
Training staff and working with partners
However, he adds, the practice, which has won an Alzheimer’s Society award for its work, has gone much further than altering the physical space. All staff are trained as Dementia Friends. In addition, the surgery runs a patient education programme for family and carers and, in partnership with voluntary and community groups, offers a range of activities for dementia patients such a weekly creative art session, which has the added benefit of giving carers a break.
Mr Radley explains: ‘The voluntary organisations provide the workshop and we provide the venue and refreshments.’
From this month, a dementia support worker from the Alzheimer’s Society will also hold fortnightly sessions at the practice offering advice and support for patients or members of the community.
‘We have worked hard on developing relationships with organisations that can improve outcomes for our patients,’ says Mr Radley.
Both Mr Radley and Dr Decker say the effect on staff of implementing such dementia-friendly initiatives in their practice has been motivating and energising since they feel they are really making a difference to patient lives.
At Overton, evaluation of the impact of the iSPACE project on dementia patients is currently taking place. Nevertheless, the initiative is spreading slowly but surely. As of February, 60 practices across Wessex have been accredited as dementia-friendly by the Wessex Academic Health Science Network. Progress is ongoing at another 112 surgeries
‘It’s a continual commitment to do the right thing,’ says Dr Decker.
Mr Boaden from the Alzheimer’s Society also says: ‘Practices that have become dementia friendly have seen wider benefits to other patients groups, especially those who are vulnerable such as the frail elderly. A practice that is dementia-friendly is better for everyone.’
- Alzheimer’s Society information on being a dementia-friendly practice, inclduing how to access free training via Dementia Friends
- More information about the iSPACE project which also lists further useful websites can be found here and here
- Developing supportive design for people with dementia from the King's Fund