The organisation is a busy suburban general practice covering an area of about four-miles radius from the surgery in the north of Plymouth. We currently have 10,500 patients across the area and are a multidisciplinary team comprised of GP's, Nurse Practitioner, Nurses, HCAs, Phlebotomist and a supporting team of administrators and managers. Each partner at the practice is committed to holding a personal list of patients. We feel this helps to ensure the quality of the patient's experience and is the best way to run a general practice. The lists are not completely strict as patients with acute problems are able to see the duty GP in the afternoon surgery but continuity is encouraged for routine appointments, especially for those patients with chronic disease. We have a patient participation group (PPG) and hold four meetings per year. the PPG has been active in providing information regarding texts, notices, signage best suited to people with dementia.
- 3 July 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?
The Plymouth Dementia Friendly City Co-ordinator attended a Practice Development Afternoon at the surgery and did a presentation for the whole team. Awareness was raised across the team and was viewed differently with different team members e.g. clinicians and the admin team.
With support from the above Co-ordinator, we undertook an audit of the premises (incorporating it with the health and safety risk assessment) to look at things from a dementia journey through the practice and are currently considering some changes. We have already made some minor changes e.g. picture signage as well as text signage.
We have a named clinical and non-clinical dementia lead.
Dementia friendly and awareness information is displayed on our carer's noticeboard.
Wherever possible, we will send a representative from the surgery to attend Plymouth Dementia Action Alliance meetings to network with other organisations and to see if any learning can be taken into our surgery.
2. What are the challenges to delivering these outcomes from the perspective of your organisation?
Updating knowledge for current staff (so learning and developing guidance and support will assist with this).
Limited budget could be an obstacle for any major changes that may be required on site.
Time pressures on staff (especially GPs) may make it difficult to fit dementia awareness in.
New staff to receive dementia awareness input as part of their induction. Induction to be updated to include e-learning dementia training.
To improve awareness of dementia across the whole team (both clinical and non-clinical) and extend to the Patient Participation Group and surgery patients.
All front line staff including: administrators, receptionists, practice manager, GPs and nurses attended a dementia awareness session (delivered by Claire Puckey-Dementia Friendly City Co-ordinator, Plymouth City Council).
For those interested to know more, staff are encouraged to utilise the e-learning resources at: www.scie.org.uk/publications/elearning. to be completed by the new Non-Clinical Dementia Lead.
Consider arranging an event at the surgery such as a health fair which could include information about dementia/dementia awareness session and local appropriate supporting organisations could be invited to attend.
Display relevant dementia-related literature and posters in the waiting areas in the surgery.
Use technology to help raise awareness i.e. include information about dementia/symptoms and invite patients to attend for screening to establish early diagnosis on the surgery website and electronic display screen.
Claire Puckey attended the March 2017 Patient Participation Group meeting at which a number of points were raised in relation to the staff awareness. KA advised that staff tend to remain at the surgery a long time so they get to know the patients personally. RA advised that care plans and annual reviews help to keep track of patients and a lot of patients remember they have an appointment and tend to arrive very early. They also tend to come into the surgery to book their appointments which means they have a printout of the appointment to aid memory. The staff do their very best to accommodate the patients' needs if any confusion arises. It was pointed out that a lot of work is in place for newly diagnosed and end of life care but perhaps not so much is done for those in the middle of these ranges.
To ensure that the surgery environment is dementia friendly.
With the support of Claire Puckey (Dementia Friendly City Co-ordinator, Plymouth City Council), a member of staff did a walk around the surgery to look at how the environment could be improved e.g. with signage changes, to ensure that it is as easy as possible for patients with dementia to access the surgery. Changes such as yellow signage and picture and text signage have been implemented.
Discussed with Patient Participation Group in March 2017 about holding a health fair at the surgery. Date to be arranged.
Ensure that clinicians are appropriately trained with the latest guidelines.
The surgery will identify any gaps in the clinical staff's knowledge about dementia and specialist training input from a local older person's mental health consultant on e.g. the latest guidelines on identifying dementia, initiating treatment etc will be arranged via Claire Puckey (Dementia Friendly City Co-ordinator, Plymouth City Council) and Rachel Silcock (Strategic Commissioning Manager, Plymouth City Council).
Improve the level of support offered to patients with dementia and their carers.
Ensure that all patients with dementia and their carers are made aware of local services that they can gain support from e.g. Alzheimer's Society, Caring for Carers, Age UK Plymouth etc.
Consider offering patients with a diagnosis of dementia and their carers, appointments with a Dementia Support Worker based in an available meeting room within the surgery, to enable them to have ease of access to practical and emotional support on a half day per month.
Encourage and promote discussion on advanced care planning (ACP) to prevent future crises (patients with dementia have a time-limited opportunity to make ACP decisions regarding financial and health and welfare matters)
Offer carers an annual health check.
Review surgery HR policies.
Support staff members if they are needed to support any family members with dementia.
Support staff members that may be diagnosed with dementia enabling them to remain in work safely for as long as possible. The practice has had previous experience of this in the past and feels this is an area that we can work on.
Identify patients with dementia and their carers, flag on surgery system and ensure all staff are aware.
Highlight patients with dementia and their carers on the surgery computer system.
Keep an up to date list of vulnerable patients and their carers.
Understand family dynamics and if there is any conflict.
Prioritise appointments and telephone conversations for patients with dementia and their carers e.g. offer appointments at a time to suit the patient and carer (always offer later ones so that a telephone reminder service can be provided on the day and also offer double appointments if needed).