The New Milton Health Centre

The New Milton Health Centre is a GP Practice with just under 10,000 registered patients from New Milton and surrounding area. 187 of our patients have a dementia diagnosis. We are part of the West Hampshire Clinical Commissioning Group and have seven GP partners. In addition to our regular doctors we have a retained GP, four practice nurses and continue to train GP Registrars. We have two attached staff: a practice Pharmacist for medicines management and guidance; and a Care Navigator who signposts patients and /or carers to other services and offers practical advice when needed. Monthly, we also run a 'Community Cafe' which is dementia focused and has representatives from the Alzheimer's Society. Patients can book time with them for confidential dementia advice. Our practice’s main aims are to be caring approachable family doctors providing the highest possible medical, nursing and social care. Working together with other support services to achieve the well being of our patients will be of the highest priority, with particular regard to their dignity. We will endeavor to provide a service that treats each patient as an individual, taking into account cultural, spiritual and social needs. We have a wide range of medical interests and we are committed to ongoing training for the doctors and all the staff.

Updated:
23 May 2018
Location:
South East
Sectors:
Care, Health
Local Alliances:
Hampshire 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?

It is said that you move to the New Forest when you retire, and you move to New Milton when your children retire. Our practice demographics reflect this idiom, with a very high proportion of people living over the age of 75. Whilst on the one hand, these self-determinant people tend to look after their health well, with the support of our proactive health services we are delivering many into extreme old age. Dementia has therefore been a focus of our clinical activity for many years.

Assessment and early identification of dementia

Our practice has the highest Dementia level in our area based on Government guidelines at over 76% and is 3rd in the CCG. If patients are concerned about their memory we offer them early formal assessment. We ensure that any formal diagnosis of dementia are sensitively communicated and are coded up accurately in the patient’s medical records. This is put as a major alert so all members of staff who access their notes are aware they have dementia. We offer them early support after diagnosis and we sign-post patients to relevant local services. To ensure that patients with advanced dementia attend reviews, where appropriate, we call them to remind them about their appointment. Patients with dementia are also offered care plans so they can make decisions now about the care they want in later life. All patients are listened to and their views considered.

Working with Carers

We respect and support all carers and aim to make them feel valued. Where possible we have identified carers for patients with dementia and have coded up these patients on our clinical system. We collated a practice directory of ‘Carer Information’: which includes information about a range of local services, including the Alzheimer’s society and carer support groups. We ensure that carers are offered a health check, flu jabs and information about respite breaks.

Practice Staff

 It is important that our growing elderly population contact services that support dementia. We therefore wish to ensure we are doing all we can to help people with memory concerns and make sure all our services are suitable for their needs. We need all our staff members to be able to help patients with dementia access our services. All practice staff have completed adult safeguarding training to ensure that they are aware of the significance of dysfunctional care seeking, for example, repeatedly attending for the same thing. They know that they should highlight any concerns about elderly patients to the adult safeguarding lead. They also know to listen to expressed concerns from families, carers and the patients themselves. Through our involvement in dementia week in 2014-2018 we have encouraged a culture where dementia is not stigmatised. Members of our practice team are trained to treat all patients with dignity and respect. Our GPs understand that people with dementia can exhibit challenging behaviour and  take time to understand why they are showing certain behaviours.

 Ensuring a Dementia friendly Environment

We have reviewed our pratice building  with the aim of ensuring it is  ‘dementia friendly’. The areas are well lit and we aim to have a welcoming face in Reception at all times. The floor is uncluttered and in plain colours. We have put up information about dementia in the waiting room and on our facebook page, which encourages patients to talk about any memory concerns.

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

Identifying people with dementia

We need to continue to encourage patients with dementia to discuss their memory concerns with their GP. If patients do not talk about their concerns they will miss out on early advice and support. We need to continue to promote openness about dementia by maintaining an environment where dementia is not stigmatised.

Practice Staff

All our staff members should be able to help patients with dementia access our services. We have carried out 'Dementia Training' sessions for all our staff. In addition to this our staff have access to yearly online refresher dementia training. Our staff induction also includes ‘dementia awareness’ training. 

Care plans

We aim for all patients with dementia to have a yearly dementia review and have a care plan in place. The care plans are very valuable in assuring patients with dementia can make decisions about the care they want in later life. They contain details about their current health and medication, their DNA CPR status and any information about next of kin/carers. Patients will need to provide us with a signed agreed copy of the plan. Logistically this can be challenging if patients forget to return signed copies to us. This therefore can take a considerable amount of GP and administrative time to achieve this goal as it has to be completed on top of existing work commitments.

Identifying all carers

Although we have recorded most of our carers, this is an ongoing process and we know we are still yet to identify some. We have established a reporting process where we collect detailed information about carers after diagnosis (if there is not yet one recorded). The patient is then contacted by our 'Dementia Champion' and the carer information is recorded in their notes and in their dementia care plan. If the carers are also our patient we need to code them up so they are offered the appropriate support.

Ensuring a Dementia friendly Environment

We have made amendments to our building to make it more accessible for people with dementia. We have added a large sign above our main entrance as it was previously not clearly sign posted. We have changed our lavatory signs to include bigger and brighter images. We also purchased new colourful toilet seatsas they were white. These will need to be reviewed going forward for wear and tear. The changes we made were be restricted by cost.

2. Actions

  • Dementia awareness for administrative and Reception staff.

    Ensure all staff complete dementia awareness training. We ran a dementia training session on the 19/8/15 for all Admin and Reception staff. Following this 15 staff chose to signed up to become a ' Dementia Friend'.  We offer yearly 'fresher' dementia training via our online staff training programme. Dementia training is part of our customer service training and new staff initiation. The training has helped our staff identify people with memory issues and sign post them to the correct services.

    Status:
    Completed

    2018 - Second Quarter Update

    We will be running a Lunch and learn dementia session on the 12th of June 2018. This is in addition to our online 'fresher' dementia training .

    2016 - Fourth Quarter Update

    3 staff members signed up to be a Dementia Friend

    2016 - First Quarter Update

    Yearly 'fresher' dementia training completed by staff.

  • Collect carers information

    Ensure we have details of all carers of a person with dementia. These details should be documented on the patient’s notes and in their care plan. We called households where we knew someone had dementia and requested carer and Next of Kin details for their medical records. The carers (if our patient) were coded up as 'a career of a person with dementia' so we can monitor numbers and invite them to our monthly Dementia focused Community Cafe and for health checks. We also recorded when there was not a carer (or NOK). We run regular reports to check that we have carer information recorded for our dementia patients. This work is ongoing due to patients being given a new diagnosis and new patients registering with us.

    Status:
    Being implemented

    2018 - Second Quarter Update

    We continue to update dementia NOK and carer information in medical records. We have set up reports to highlight any missing data.

    2017 - Third Quarter Update

    Each Quarter run report on all pateints with Dementia to ensure they have an NOK documented in their records.

    2017 - Second Quarter Update

    In May 2017 we put up a display in our main entrance to encourage patients to let us know if they are a Carer. this was left up until August.

    2017 - Second Quarter Update

    Each Quarter run report on all pateints with Dementia to ensure they have an NOK documented in their records.

    2017 - First Quarter Update

    Each Quarter run report on all pateints with Dementia to ensure they have an NOK documented in their records.

    2016 - Fourth Quarter Update

    Each Quarter run report on all pateints with Dementia to ensure they have an NOK documented in their records.

    2015 - Third Quarter Update

    Each Quarter run report on all pateints with Dementia to ensure they have an NOK documented in their records.

    2015 - Second Quarter Update

    Each Quarter we run a report on all patients with Dementia to ensure they have an NOK documented in their records.

  • Care planning for patients with dementia.

    Ensure all patients with a formal diagnosis of dementia are identified and have a care plan. Due to the nature of this action this will be ongoing as we get new patients.

    Status:
    Being implemented

    2018 - Second Quarter Update

    This is ongoing. Our patients with Dementia have care plans and are reviewed at least once a year.

  • Educating patients about dementia, local dementia services and to express any memory concerns with GPs.

    Establishing a ‘Dementia information’ area in the waiting room where patients can get information about dementia. This information is regally updated and is also available on our website under our 'Dementia Friendly' page. Since May 2016 we have run an inclusive 'Dementia Friendly' community cafe which aims at sign posting patients to Dementia support services and encourage our patients with dementia to socialise. From Summer 2017 patients can also book appointments with Alzheimer's Society Advisors during the running times of the cafe. Members of the practice also supported New Milton Town to become dementia friendly and we encourage our patients to get involved with their work and services.

    Status:
    Completed

    2018 - Second Quarter Update

    Took part in Dementia Awareness Week 2018 and ensured the 'Dementia information’ area in the waiting room was up-to date.

    2017 - Third Quarter Update

    Dementia advisor infomation posters put up. 

    2017 - First Quarter Update

    Took part in Dementia Awareness Week 2017. Put a display up in the main entrance and infomation of our website and Facebook Page.

    Ensure 'Dementia information’ area in the waiting room is up to date.

    2016 - First Quarter Update

    Took part in Dementia Awareness Week 2016. Put a display up in the main entrance and infomation of our website and Facebook Page.

    Ensure 'Dementia information’ area in the waiting room is up to date.

    2015 - First Quarter Update

    Took part in Dementia Awareness Week 2015. Put a display up in the main entrance and infomation of our website and Facebook Page.

  • Making a carer information leaflet.

    Creating a leaflet which contains our collated information for carers. Since becoming dementia friendly we have collected may more useful leaflets and organisation details to support carers access support and activity groups.

    Status:
    Completed

    2018 - Second Quarter Update

    Practice carer leaflet reviewed.

  • Review practice signs.

    We have invested in a large main entrance sign and made our signs for departments clearer . We have put up new 'image' toilet signs. We have also put up exit signs so that people can navigate the corridors with more ease.

    Status:
    Completed

    2018 - Second Quarter Update

    Patient areas reviewed to ensure they are as dementia friendly as possible.