The Bellingham Practice
Bellingham Practice is located in northern Northumberland and covers an area extending over 800 square miles. Within our catchment there are both remote and isolated individuals and communities. Infrastructure, including transport links are poor. This presents challenges when trying to deliver equitable holistic care which has parity with other areas of the country. The well-established practice serves a community of approximately 3500 people. The established medical team is made up of 3 part time GP Partners. As a training practice we also have GP Registrars who generally work in the practice for periods of six months. We also regular have medical and nursing students attached to the practice. Being keenly aware of the rurality of the practice we provide as many services as we can within the village. Practising from the surgery we provide services to include - Podiatry, Physiotherapy, Midwifery, Counselling and retinal screening – this is in addition to the Practice Nurse, Health Care Assistant, Diabetic, Asthma, Chronic Obstructive Pulmonary Disease clinics , The Community Nurses and Health Visitor.
- 26 November 2019
- North East
- GP Surgery
- Local Alliances:
- North East Dementia Alliance
1. Action Plan
1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?
We are keenly aware of the challenges to delivering the 5 outcomes set by the National Dementia Declaration.
The aim is to ensure those living with a diagnosis of dementia are given choices and become partners in the management of their own care, they remain active and included within their communities, have timely access to evidence based care and are aware, and have access to research materials as they become available.
As a practice we are constantly striving and reviewing the quality of the care we are able to offer. We appreciate delivering good care is not only the right thing to do but the declarations are enshrined within both the Equality and Mental Capacity legislation, Health and Social Care legislation and International Human Rights Law.
We foster a caring culture.
We lead by example and any new members of the team are expected to follow the high standard we set for ourselves.
We are a relatively small practice and we work closely together affording excellent communication between both the immediate team and other external services.
We tap into the strengths of village life balancing concern from others with confidentiality of the patient.
We are proactive in promoting dementia care within the practice and we are supportive of any new initiatives that are suggested for the area.
Supporting evidence can be seen in our action plans that follow.
2. What are the challenges to delivering these outcomes from the perspective of your organisation?
We have great ambition to continue improving the care we are able to offer our patients diagnosed with dementia. However in reality there are restrictions that can curb our ambition.
The declaration encourages choice – and we work to empower the patient and give them the opportunity to choose – however due to our rurality we do not always have the infrastructure in place to afford them that opportunity eg We have so few care providers available to support an individual at home – sometimes there is no real choice for them if their condition is advancing.
Limited transport links again feed into the reduction of choice. Individuals who reside in more remote parts of the practice area may not be able to maintain the connection with their community and the valuable support networks are lost.
Limited resources have to be balanced – (both financial and workforce hours) means as a service we have to be able to deliver equitably standard of care across the whole of our caseload and although dementia is an obvious priority – other patients cannot be marginalized at their expense.
We have to acknowledge that although we strive to deliver an evidenced based and holistic management plan for each individual – we have to respect that not all patients will want to engage with what evidence suggests is the best practice.
Contact Name: Jayne Reed
Work Address: The Bellingham Practice
Bellingham, Hexham, Northumberland, NE48 2HE
Phone: 01434 220203
To maintain Dementia awareness for all staff and to encourage the community to have a general understanding of the condition.
We have recently held an in- house Dementia Friends session that most of the staff were able to attend – (for many it was an update). We have staff who lead on Dementia Care within the practice who would be acknowledged as Dementia Champions, this will dove tail into our in - house statutory training and allow us full control of our ongoing training needs – in respect of dementia care. We aim to further raise awareness of dementia within the team accessing external training as it becomes available.
We also hosted a well-attended community Dementia Friends session – that has sparked some ideas from the community about services they may able to bring into the village. We are offering our full support in promoting the new services and providing practical help – in the form of meeting rooms free of charge.
1.We have built upon the fundamental knowledge our team possesses (both clinical and non-clinical) – the refresher course reinforces the presenting symptoms of those patients with cognitive deterioration
2. The staff now have at their fingertips more understanding and empathy to ensure all exchanges (face to face and telephone conversations) are conducted appropriately. We want to ensure all patients visiting the surgery feel comfortable and safe with all the medical centre staff.
Working as a proactive catalyst in the diagnosis and management of those living with dementia.
In accordance with protocol we have an up to date caseload that is proactively screened for cognitive deterioration – and a pathway of diagnosis in place.
Any findings are prominently recorded within the electronic record – which will result in all staff being immediately aware of the patients’ cognitive deterioration and be able to adjust their behavior accordingly.
We have an excellent resource within our community – we are alive to the concerns people living in the village may report to us regarding changes in an individuals’ behavior or coping ability – ensuring confidentiality is not breached we sensitively investigate if there is any need for intervention and discuss and document it in our regular team meetings.
We are keen to encourage those living with dementia to maintain their independence and social engagement. We practice anticipatory care management.
Evidence suggests that a more positive outcome is likely – when a timely and appropriate support network is put in place to help support both the individual and the carers. This is a step we regularly discuss in team meetings when we regularly review patient care and management.
Signposting people into the legal system - so both the legal and financial implications of a dementia diagnosis can be explored.
Having the correct Power of Attorney in place allows for seamless care if conditions deteriorate and it ensures that the wishes of the individual can be carried out if they are no longer able to make fully informed decisions. This is again prominently highlighted on our electronic record system.
Furthermore – the medicine management team is proactive in checking that those living with dementia are able to cope with their daily medication – and if appropriate suggest a dispensed dossette box is used if it helps with clarity.
Although a lot of these measures are employed at some point by many surgeries – we pride ourselves on being proactive and having the foresight to put effective measures in place to support the individual and the National Dementia Declaration.
Ensuring the Physical safety of any vulnerable individual.
Although stunningly beautiful the rurality of our communities can make them a potential risk for anyone with confusion / dementia.
If patients’ wonder and stray into unfamiliar territory it can be stressful and potentially very dangerous for both the individual and their carers.
We are aware of the Herbert Protocol in operation with Northumbria Police Force and are working to raise awareness of this with carers and families living with dementia. This is a pre-emptive safety measure that ensures relevant information is completed in advance – which can be immediately handed to the police if the individual goes missing – thereby saving valuable time in mobilising services to help.