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NHS Harrogate and Rural District CCG

Harrogate and Rural District Clinical Commissioning Group (CCG) is the NHS organisation that commissions (or buys) health services for the residents of the Harrogate and Rural District locality. We represent 18 GP practices and serve a resident population of approximately 160,000 people

25 February 2015
Yorkshire and Humber
Health, Clinical Commissioning Group
Local Alliances:
Harrogate and Rural District Dementia Action Alliance, Yorkshire & Humber Dementia Action 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?

As the commissioner of health services in the Harrogate and Rural District the CCG is responsible for

  • commissioning, and monitoring the quality of, services to diagnose dementia at the earliest time appropriate for the individual person
  • ensuring the optimal physical and mental health of people with dementia and their carers, including appropriate use and monitoring of medication
  • working in a co-ordinated way with our partners in Social Care and the Third Sector to provide long term monitoring and support for people with dementia and their family. This includes working closely with Care Homes
  • ensuring that high quality end of life care is available when  appropriate

2. What are the challenges to delivering these outcomes from the perspective of your organisation?

The major challenge we face is to improve the quality and capacity of the services we commission when the funding available does not match the increasing prevalence of dementia.

We also have more Care Home beds (per head of population) than any other CCG in the country and large numbers of people in Care Homes have dementia. The development of innovative ways of working, and integrated working with partners in Social Care to simplify pathways and improve long term support, are essential developments in the near future.

2. Actions

  • Improved Support for People Living in Care Homes

    In 2014 each local Elderly Care Home was linked with a single GP practice. This has allowed better continuity of care, more planned care and routine reviews for Home residents and better relationships between nurses and carers in the homes and the GP.

    As part of the same initiative the capacity of specialist mental health liaison to the Care Homes was doubled, enabling support and advice for people with dementia and educational input about dementia for Care Home staff.

  • The Harrogate and Rural District Dementia Collaborative

    This was a 3 year Large Scale Change Project, ending in 2014, involving collaborative working between the CCG, Social Services, our local Foundation Trust, our Mental Health Provider, the 3rd Sector, people with dementia and Carers, to transform aspects of the Dementia Pathway identified by all parties at the start of the project.

    Outcomes of the project included shortening waiting times at the Memory Clinic, improving diagnosis rates in Primary Care, improving care for people in Care Homes by change in record keeping and communication between staff, enabling the Foundation Trust the improve their environment for people with dementia, improving information about dementia for patients and carers and improving carers assessments.

  • Increasing capacity of the Memory Clinic by changing the follow up of people on medication for dementia

    Every person on medication for dementia was being followed up twice per year in the Memory Clinic (as recommended by NICE guidance). A new arrangement was developed allowing follow up to be shared between the Memory Clinic and the person’s GP. This enabled the patient to have reviews more conveniently closer to home and released 700 appointments from the Memory Clinic that can be used for people with more complex problems and for new diagnosis

    Implementation, Delivery
  • Improving diagnosis rates across the CCG area

    Every GP practice in the CCG has signed up to the new Enhanced Service to encourage diagnosis of Dementia, and committed to running the Dementia Toolkit, which helps people with dementia are properly coded in the GP record, so allowing people with dementia be identified and supported.

    This project is ongoing (due for completion in March 15) but Harrogate and Rural District currently has a dementia diagnosis rate significantly above the national average, and the highest in North Yorkshire. We are also arranging an educational event, led by Dementia Forward, around dementia for all local GPs in February.

  • Moving the diagnosis of dementia into the community

    The CCG is working on plans to move the diagnosis of dementia into the community and attaching a Dementia Support Worker to every practice. This will allow assessment and diagnosis closer to home and in a less stressful environment and also allow people with dementia to have a named Support Worker before, during and after diagnosis.

    Specialist services at the Memory Clinic will be better able to help people with complex problems and younger people with dementia, and in addition there will be better relationships between primary and secondary care. It is also hoped that there will be greater coordination with Social Services in the support of people with dementia.

    The target for implementation of this new pathway is April 2015.