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North Street Surgery

General Practice in the centre of Keighley We are a small family practice in the centre of Keighley supporting over 6,700 patients. We aim for the highest quality care and performance by employing and supporting high caliber, well trained staff. We provide extended services in the surgery to bring care closer to the patient and we encourage all our clinicians to developing a specialist interest and also in supporting the local CCG and other regional and national organisations in developing better services for all patients. We strongly believe in training and development and support training of our future doctors, nurses, GPs and ancillary staff.

21 May 2017
Yorkshire and Humber
Local Alliances:
Bradford District 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?

On a Local and Regional level, one of the Westcliffe Alliance Partners Dr Sara Humphrey has developed a Specialist Interest in Care of the Elderly and now supports the Bradford City & Districts Clinical Commissioning Groups, Bradford Dementia Strategy Group and the Y&H Strategic Clinical Network in developing services and pathways to support both patients with Dementia and their Carers. This has involved developing self-care and advance care planning resources to ensure patients and carers have personal choice and knowledge to live their lives well, as well as ensuring that services are designed around their needs.

On a practice-based level we are a new practice to the Westcliffe Alliance and will be lead by Dr Sara Humphrey as  the new lead partner and we know we have a low prevelence of patient with known Dementia and we know we have a 'gap' and that we need to actively find our missing patients with Dementia to ensure thay have access to a diagnosis and support .We are now ensuring that all our patients with known Dementia have Care Plans in place to ensure they live their lives well and they get the support they require.

We are also planing to become a active Research Practice led by  Dr Sara Humphrey ( who also leads the Bradford Research Clusters ) and will be encouraged the practice to actively engage in the 'Join Dementia Research 'Campaign.

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

The NHS like other organistations as been hit by the government auserity measures which means that it is a challenge to maintain a high level of service despite falling incomes and difficulties with recruitment.

Our practice is also relatively new to the Westcliffe Alliance ( following an emergency tender from the CCG) and is small and has a relatively high deprevation index with a lower than expected Dementia prevelence.

We are trying to meet these challenges with new ways of working.

Once a diagnosis has been established, a more considerable challenge is ensuring Care Planning of all types is undertaken in a meaning & engaging way with patients and their carers, so it makes a difference to their lives. This not only involves staff awareness training but also education on the care planning process

2. Actions

  • Raising Awareness of Dementia amongst staff

    To invite a Dementia champion in to one of our practice PLT events and encourage all staff who do not normally attend to go on Dementia Friends website and watch the 5 minute video

    Initial Scoping
  • Raising Awareness of Join Dementia Research and research generally

    The practice is going to request to become a Research Active Practice and we would like to get involved in recruiting patients to Dementia related research and also in helping patients to access research via Joint Dementia Research.

    We will patient notice board show casing how they can get involved in research and what studies we are recruiting to at present.

    Initial Scoping
  • Ensuring the surgery is supportive and enabling when patients with Dementia and their carers access our services.

    All staff to undertake Dementia Friendly awareness so they have an awareness of the condition and understand the person behind the diagnosis. All staff will wear dementia friendly badges and we sign up to Hello my name is....

    Initial Scoping
  • Increasing the Dementia Diagnosis Rate by undertaking the National DQT audit and improving access for hard to reach groups

    To undertake the national coding audit ( DQT) to look for patients with Dementia who have not been coded appropriatly.

    To raise awareness of Dementia with staff to ensure that support patients to actively receive a diagnosis

    To start promoting and using the new Y&H SCN tool:DiADeM – Diagnosing Advanced Dementia Mandate,To helps support awareness and  diagnosis of Advanced Dementia in Care Homes .This will help support the Care Planning and End of Life Care

    Being implemented
  • To ensure suitable policies ,resources,audits and training are in place around Safeguarding,Mental Capacity Act,DoLs,Care Planning and Antipsychotics


    1) To ensure the practice have up to date policies and procedures for Safeguarding Adults, Mental Capacity (including DoLs)

    2) To ensure the practice has a named Adult Safeguarding Lead and they have accessed suitable training and awareness around, Safeguarding Adults, MCA, Dols, and Dementia

    3) To plan a yearly Safeguarding Adults and Children’s event for staff to ensure they know how to spot the signs of abuse, access support and make an alert

    Practice Yearly event planned for September 2017


    System resources developed by our practice Lead Dr Sara Humphrey with the other Clinical Leaders, CCG,SCN and CSU for Advance Care Planning, MCA, Dementia Care Planning, Self Care and now all available and accessible on System One Practice Master Template


    Yearly audits on Y&H Dementia DQT Audit, QOF, Antipsychotics etc undertaken

    Being implemented