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Care Homes Medical Practice

The Care Homes Medical Practice is a unique general practice providing medical care to older people living in residential and nursing homes within the city of Salford, Greater Manchester. The multidisciplinary in-reach team includes GPs and specialist nurses. There is high prevalence of people with dementia registered with the practice, we are committed to continuous improvement and support for people with dementia, their relatives and care home staff in dementia care. The Care Homes Medical Practice is part of Salford Royal NHS Foundation Trust and aims to provide continuity of care for patients across the hospital and community. Salford Royal NHS Foundation Trust is an integrated provider of hospital, community and primary care services, including the University Teaching Hospital. We aim to be the safest organisation in the NHS through providing safe, clean and personal care to every patient, every time.

Updated:
4 March 2016
Location:
North West
Sectors:
Hospitals and Hospital Trusts
Local Alliances:
Salford Dementia Action Alliance

1. Action Plan

1. The National Dementia Declaration lists a number of outcomes that we 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 Care Homes Medical Practice is committed to delivering better outcomes for people with dementia living in care homes through:

  • Quality and Outcomes Framework (QoF).
  • Enhanced service specification, facilitating timely diagnosis and support for people with dementia.
  • Clearly defined Key Performance Indicators for dementia (including awareness training, reduction of antipsychotic drugs, case finding new dementia diagnoses).
  • GP and specialist nurse leadership.
  • Staff Training.
  • Integrated working with community, local authority, mental health and voluntary sector services.
  • Improving end of life care.
  • Quality Improvement.

2. What are the challenges to delivering these outcomes from the perspective of your organisation?  The challenges that we face in delivering improved outcomes include:Increasing demand for dementia care interventions due to high prevalence of people with dementia registered with the practice.

  • Workforce development in relation to case finding new diagnoses.
  • Providing systematic training to care homes across the city of Salford.
  • Sharing of information between services.

2. Actions

  • Facilitating a timely diagnosis

    The Care Homes Medical Practice completes a cognitive assessment with each consenting patient registering with the practice. Any concerns regarding cognitive impairment are followed up by dementia clinical nurse specialist or appropriate clinician. Following further review and investigations referrals are made to the memory assessment and treatment service.

     The practice will sign up to NHS commissioning Board enhanced service specification to facilitate timely diagnosis and support for people with dementia. The enhanced service specification encourages GP practices to undertake a proactive approach to the timely assessment of patients who may be at risk of dementia.

    Status:
    Being implemented

    2015 - First Quarter Update

    The enhanced service specification is continued. The aim is to identify patients at clinical risk of dementia, offer an assessment to those at risk, offer a referral to memory clinic where dementia is suspected.

    2014 - Fourth Quarter Update

    The GP practice has signed up to the enhanced service specification.  The practice is able to audit assessments for dementia completed and referrals to memory service.

  • Reduction of antipsychotic drugs

    One of the key aims of the Care Homes Medical Practice is to review, reduce and stop use of antipsychotic drugs in people with dementia. The practice has a treatment pathway in place which encourages care home staff to follow guidance in Optimising treatment and care for people with behavioural and psychological symptoms of dementia (Alzheimer’s Society, 2011) and  Alternatives to antipsychotic medication: psychological approaches in managing psychological and behavioural distress in dementia (British Psychological Society, 2013. These guidance documents promote a person centred approach to care which include a period of watchful waiting, use of behavioural charts and evidence based alternatives to antipsychotic medication. 

     The dementia clinical nurse specialist provides training to care home staff and clinicians within the practice. Non-pharmacological approaches to managing behaviours that challenge are advocated.

    Each person with a diagnosis of dementia who is prescribed an antipsychotic drug has their clinical records reviewed in order to establish clinical indication. Newly initiated atypical antipsychotics should only be prescribed by specialist services and have a shared care protocol in place. Potential side effects are discussed with the person with dementia, care home staff and family. If the person with dementia lacks capacity regarding taking prescribed medication a best interests meeting will take place. Antipsychotic drugs are reviewed regularly and reduced / stopped whenever possible.

    Status:
    Delivery

    2014 - First Quarter Update

    Three monthly auditing carried out by our pharmacy technician has improved drugs being stopped and reduced. This will be on-going.

  • Workforce training

    The dementia clinical nurse specialist working in the Care Homes Medical Practice will deliver appropriate training and offer support and advice to care home staff, people with dementia and their carers, clinicians in the practice and staff working in the community and hospital setting.

    Status:
    Delivery

    2014 - First Quarter Update

    On-going. Focussing on supporting staff in care homes to provide individualised care. Providing advice for assessment, examples of this include pain, sleep problems, behaviours that may challenge

  • Partnership working

    The Care Homes Medical Practice is committed to partnership working. As part of an integrated care project a test of change has been developed with Salford mental health trust.  The project enables GPs, Consultant Geriatrician, Consultant Psychiatrist and dementia clinical nurse specialist to meet regularly to provide timely patient care and share best practice.

    Status:
    Delivery

    2015 - Third Quarter Update

    The integrated care project meetings remain successful. A Consultant Psychiatrist employed by Greater Manchester West mental health trust has now been appointed to work with the Care Homes Medical Practice.

    2015 - First Quarter Update

    The integrated care project continues with dates for consultant psychiatrists from Greater Manchester West mental health trust booked until December 2015

    2014 - First Quarter Update

    The integrated care project has proved to be a success in reducing referrals and providing timely interventions. Dates for meetings with Greater Manchester West mental health trust are booked until December 2014

  • Music therapy for people with dementia living in care homes

    A Prescription for Music. Although many people with demetnia living in care homes may have significant cognitive difficulties, they may still be able to enjoy music. Musical memory can remain intact even when other memories are severely impaired. The Care Homes Medical Practice was awarded funding for individualised music through use of headphones for people withe dementia and cognitive impairment living in care homes.

    Status:
    Being implemented

    2015 - Third Quarter Update

    The project is ongoing. Initial evaluation has found in some cases individualised music for people with dementia living in care homes can reduce distress during interventions, reduce the need for psychotropic medication and improve psychological wellbeing