What are cookies?

Our site uses cookies. A cookie is a small text marker stored on your computer that enables us to track the use of our website. We use cookies to help us understand what our users' interests and preferences are to ensure the website is as user friendly as possible.

This site only uses cookies in order to provide a service to visitors. No personal data is stored in cookies and cookies are not used in order to provide advertising. Cookies are used for the following purposes:

Learn more about cookies on aboutcookies.org

If you have any concerns about the processing of your personal data by the Dementia Action Alliance, please contact the Secretariat, c/o Alzheimer's Society, 43-44 Crutched Friars, London, EC3N 2AE.

Accept and continue

Abbeywell Surgery, Romsey

We are a general practice with a population of 19,000 patients. Of those patients we currently have 177 patients with a recorded diagnosis of Dementia.

26 February 2019
South East
Care, Health, Medical, GP Surgery
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?

Abbeywell Surgery will continue to work with their identified dementia champions to maintain and grow dementia awareness within the Practice for both staff and patients.. We continue to work with our Patient Participation Group (PPG) to audit both sites to identify any improvements/adjustments which can be made. We will repeat the review of use of anti-psychotic and other dementia drugs with our Pharmacist and lead GP. We will continue to identify carers who will be  included in correspondence, offered a health check and referred on for support if required.

We intend to organise, through our PPG, an education evening on Dementia and will invite patients living with dementia to speak of their experiences.

We regularly use our Transformation Team who have a range of clinical and social skills and experience to support patients to remain independent within their own homes and to put them and their families in touch with other relevant agencies, guidance on paperwork etc.

An annual review invitation is extended to our dementia sufferers. The Practice Manager and Lead GP meet 6 monthly to review our processes. As a result we add alerts to patient records in order to make staff aware that extra help may be needed in organising appointments, being flexible etc.  Carers are also coded on our system and GPs will ask if they require a separate review.

Abbeywell is a prominent research practice.  We are positive in signing up to studies focusing on dementia patients.  They are, of course, invited to participate and may accept or decline to take part.

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

Abbeywell Surgery is one practice operating across 2 separate sites which may cause anxiety to dementia sufferers.  When possible, they will be offered an appointment with their named GP for continuity and familiarity.  This is an area to consider while we work on an alternative appointment system.

Staff departures can also prove challenging, particularly if they are a dementia champion.  We need to ensure new staff are made aware of and trained in this role.

Budget can be a challenge, but we have a rolling improvement programme in place so dementia friendly replacements will gradually take place, ie coloured toilet seats and door mats which are not dark in colour.



2. Actions

  • Patients to be identified to staff

    Patients records will have an alert added to make staff aware that they have a diagnosis of dementia and to help them accordingly.


    Being implemented
  • Staff training programme to be implemented

    Practice Manager and dementia champions to gather education materials and set training dates.


  • Use of anti-psychotic/dementia drugs to be reviewed

    Our pharmacist will work through our patient list to review current medication.


    Initial Scoping
  • Patient Participation Group to audit both sites

    he Practice Manager will provide the Group with the appropriate audit and discuss feedback received from them once completed.


    Initial Scoping
  • Spreadsheet in place identifying dementia patients, carers and date review care plans reviewed.

    Practice Manager to develop workable spreadsheet

    Being implemented