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Prescott Surgery, Baschurch

Healthcare/Primary Care – Doctors Surgery

16 April 2019
West Midlands
Health, Care, Medical
Local Alliances:
Shropshire, Telford & Wrekin 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?

Prescott Surgery wishes to become a member of the Shropshire and Telford DAA to help achieve our vision for patients living with dementia.  Our vision is “to enable you to remain you, to live well in your community, to feel secure and with those around you, to feel confident and informed, knowing where to go when you need help”.

The actions we have agreed to take will help our patients and their carers to live well with dementia.  Our staff will gain new knowledge and skills to enable them to assist patients and carers with a greater effectiveness.  The GPs will be able to support patients with a greater effectiveness.  The patient group are so enthusiastic to give their time to support the surgery and to eventually expand this initiative into Baschurch as a community, working with local services, the schools, the Church and others to eventually enable Baschurch to be a Dementia Friendly village.

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

The main challenges will mainly be time and resource.  We intend to overcome this by having a DF lead from the clinical team, the admin staff and also the volunteer patient group. 

The action plan has been considered thoroughly following a discussion with all the GP partners, the staff and the patient group.  Full commitment has been given to achieving the actions and gaining positive outcomes for the patients.

Member website


2. Actions

  • Improving the whole practices understanding of dementia

    • We will deliver dementia training for all practice staff via ‘dementia friends’ sessions held in the surgery and facilitated by a local dementia champion. We will encourage all staff to view the online video ‘Insights on living with and caring for those with dementia’ by Dr Jennifer Bute (a GP with dementia) http://www.gloriousopportunity.org/dvd2.php/ and give them protected time to do this.
    • All staff will be provided with the Alzheimer’s Society booklet for Understanding Dementia For Customer Facing Staff in order to increase their knowledge and understanding of how to support a patient who has dementia.  This will be part of their CPD.
    • We will work with the local action alliance group and consider the role of a dementia champion(s) within the extended practice team- this is likely to be the lead GP who is working with us, a member of staff and a member of the PPG
    • We will use appropriate language when talking about someone with dementia using the DEEP guide for reference.
    Being implemented

    2018 - Third Quarter Update

    New member

  • Raising awareness of dementia at every opportunity within the practice for the benefit of our partners and their carers

    We will ensure that we have appropriate up to date literature available to all staff and patients within the practice and provide displays that are kept up to date. We will also make information available via the practice website.  We will develop two information binders for patients and also for carers of people with dementia.

    We will use our display boards to promote awareness of dementia and to invite patients to attend screening or raise concerns.

    We will actively identify patients who are ‘at risk’ of dementia and ask about memory concerns opportunistically during any contact with the clinical team

    We will encourage a culture where dementia is not stigmatised

    We will hold an event during Dementia Action Week (DAW) every year.

    We will review our environment by looking at space, signage and facilities for our patients in line with the DAA and ispace guides.


    2018 - Third Quarter Update

    New member

  • We will improve diagnosis rates at the practice

    • We will ensure that we ask screening questions to all ‘at risk’ patients and do a formal assessment when someone is concerned about their memory. We will ensure that we follow the agreed referral pathway.
    • We will ensure that all new diagnoses are captured and coded correctly and audit codes such a ‘cognitive decline’,  ‘memory disturbance’, ‘Alzheimer’s’, ‘vascular dementia’ & ‘mixed dementia’ etc. to ensure that they have been converted to a dementia code once a formal diagnosis has been made.
    • We will continue to compare our data with local and national averages and aim to achieve the ‘expected’ prevalence for our practice population.
    • We will encourage use of ‘This is me’ document file:///C:/Users/suttem/Downloads/Alzheimer_s_Society_This_is_me_booklet_onlinev.3.pdf

    2018 - Third Quarter Update

    New member

  • We will work in partnership with carers of patients with dementia to provide support and improve wellbeing

    • We will identify carers. In some cases this will be by sending them a letter via the patient to ask them to identify themselves.
    • We will code the carers and involve them in decision-making and care decisions.  
    • We will create a Carers Register so that all staff at the surgery easily identifies them.
    • We will explore mechanisms of improved communication to carers whereby carers are copied in to hospital referral letters so that they are aware of appointment dates.
    • We will provide carers and patients with a list of ‘helpful contacts’ in the area and ensure this is available to carers.
    • We will enlist the support of the voluntary sector to support the carers of our practice.

    2018 - Third Quarter Update

    New member