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Dr Lee and Partners - GP surgery

We are a large GP surgery based on 3 sites in Calverley , Farsley and Bramley. The practice has over 17,000 patients and we have 12 GPs, 5 practice nurses, 4 health care assistants and also administrative staff. We are a family friendly practice who try to provide a high standard of care with continuity of care being a high priority. We pride ourselves on expertise in caring for chronic health problems and have a dedicated community matron providing support for the elderly.

9 February 2017
Yorkshire and Humber
Care, Medical
Local Alliances:
Leeds 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?

Our aim is to become a dementia freindly practice by implementing and amended version of the SPACE principles for dementia care which are used in the hospital setting. This involves 1. Identifying all patients who have dementia.2.Staff training- clinical meetings/reading material.3.Partnership with carers- identifying carers and ensure they are involved and invited at all stages of patients journey. Offering carer support.4.Assesment and early identifiction of dementia-early support after diagnosis.5. Care plans which are pt centred. 6.Enviroments which are dementia friendly.


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

The main challenges are involved in training staff across all the sites to become skilled in caring for people with dementia and trying to give enough time to care. There are issues in trying to organise support for carers who may have been usedto struggling on alone. We are also trying to organise hospital appointments etc to be sent to carers as well as the people with dementia which is an administrative challenge. We also need to look at our record keeping to make it easier to identify carers and also to improve care plans to make them more person centred.

Member contacts


Member website


2. Actions

  • Support for carers with dementia

    We have identified those patients with dementia and invited them to identify their carers as well as leaving literature in the waiting room for carers. We have followed this us by starting carers clinics run by our community matron and memory support worker to provide physical health checks alongside emotional support and practical advice.


    2017 - First Quarter Update

    We have now established carers clinics and also a memory support worker to help carers. She is employed by Leeds NHS/Alzheimers society and her input has been greatly appreciated

  • Making sure staff have training on dementia care

    We have already completed an initial training event with help from the Alzheimer's society and are planning a further training session to be aimed at reception staff with the aim of supporting them at the surgery or during telephone contacts.

  • Community Matron to improve level of care

    We have employed a community matron whose main focus is care of the elderly - in the surgery, at home and in the nursing home setting. The matron will ensure that patients at high risk are asked about their memory and offered a screening test if appropriate. This will lead to earlier diagnosis and then support after diagnosis.


    2017 - First Quarter Update

    We have a risk of dementia register which we are using to identify patients and the community nurse is working closely with us to provide early identification of people with dementia and offer support