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Yelverton Surgery

The surgery provides General Medical Services to a population of 7250 patients. Located to the north of Plymouth, the practice covers one of the largest areas in England, being a predominantly rural area. Our boundaries extend from Grenofen, near Tavistock, Roborough, Dartmeet, Postbridge and Bellever. We have a mixed demographic of some rural deprivation and a higher than average number of patients over the age of 65 years. We are a multidisciplinary team of GP's, GP trainees and nurses supported by receptionists and administration staff. We also work closely with our District Nurses, Health visitors and other Health Professionals and teach 3rd and 4th year Medical Students. Our surgery team prides itself on providing a high quality, friendly service to our patients. We encourage patients to see the same doctor to provide continuity of care but every patient has the choice to see whoever they wish.

30 June 2017
Local Alliances:
Plymouth 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?

Many of our staff are aware of the term dementia but they are not familiar with the best way to deal with those patients. By attending an awareness session with the Dementia Friendly City Co-ordinator from Plymouth City Council, it is hoped that awareness will be heightened, knowledge will be developed and in the long tem, provide an improved service and experience for our patients with dementia.

In conjunction with the Co-ordinator, we have undertaken an audit of our facilities to ensure they meet the needs of patients with dementia.

Where possible, we will send a representative of the surgery to attend the Dementia Action Alliance meetings. This will enable us to network and learn from other organisations.

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

Current staff being able to attend an awareness session outside of their work hours-we have many part time staff who have child care commitments.

Limited funding could pose an obstacle to major changes required at the surgery premises.

New staff will need dementia awareness input as part of their induction training.

Time and organisation pressures may mean that attendance at meetings may be difficult.

Ensuring that all new patients diagnosed with dementia are identified with a "pop up note" so that all staff are aware of their particular needs.

2. Actions

  • Ensure that all patients who wish to, have an up to date care plan and TEP (Treatment Escalation Plan) in place.

    Ensure that a care plan and TEP is in place in conjunction with patient and family.

    Ensure that all patients and their cares are aware of local services to support them e.g. Alzheimer's Society, TASS (Tavistock Area Support), CAB, Yelvercare, Age UK.

    Offer cares an annual health check with Devon Carers-On Mondays each week we provide a room for Devon Carers to see our patients and their families.

    All patients using anti-psychotics who are also diagnosed with dementia have been reviewed by a doctor.

  • To improve awareness of dementia across the whole team (both clinical and non-clinical) and address environment issues as identified in our 'Dementia Walkthrough'

    All staff will attend an awareness session delivered by either Claire Puckey (Dementia Friendly City Co-ordinator, Plymouth City Council) or Dr Kat Holden, Dementia Champion.

    All staff will be encouraged to complete the E-learning module for Dementia Awareness on our Bluestream Training.

    All patients with a diagnosis of dementia will have a "pop up note"  which will indicate they have dementia. This will be useful for receptionists when booking appointments as they can assist patients by making appointments later in the day and suggesting that the date and time is written down.

    Each member of staff will be given "A Guide For Customer Facing Staff" from the Alzheimer's Society.

    Staff will be involved in making changes to the environment, for example, different coloured posters and signs for exits. Signs for toilets will be depicted by use of a picture.

    Each month in our waiting room we provide information on a topic which may affect out patients, their families and their carers. We will dedicate one of our months to dementia.

    We have ordered a different coloured toilet seat for our disabled toilet.


  • Ensure that our doctors and nurses are appropriately trained in accordance with the latest guidelines.

    Dr Kat Holden, Dementia Champion, will undertake a piece of work to identify gaps in GP's knowledge of support services available.

    Dr Holden will hold an awareness session for clinical staff regarding support within the community for patients and their families and carers.

    Dr Holden will produce a comprehensive information sheet to aid clinical staff with signposting.