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?

Forge Close Surgery intends to be a Dementia Friendly Practice

Dementia is the biggest health and social care challenge of this century.

At Forge Close Surgery we believe that it is important that people with dementia can visit their GP and get the care and support that they need.

We recognise that general practice is important for people with dementia.

General practice acts as a gatekeeper for key aspects of care for people with dementia. General practice can provide information and signposting to patients with dementia; and their families or carers to enable them to access appropriate support;

General practice is responsible for dementia care plans and reviews for ongoing management.

The purpose of this Action Plan is

To ensure that Forge Close Surgery adopts and maintains dementia friendly practice;

To enable people with dementia have a positive experience of primary care; and

To enhance quality of life for people with long term health conditions including dementia.

Being a dementia friendly general practice will have benefits including:

Improving quality of care and support for people with dementia

Improving quality of care and support for other patient cohorts

Supporting national frameworks and standards for diagnosis of dementia and the treatment and management of people with dementia

Supporting key lines of enquiry of the Care Quality Commission

Reducing missed appointments and repeat appointments

Increasing dementia awareness and understanding for all practice staff, as well as contributing to personal development and job satisfaction.

We aim to achieve this by making small feasible adaptations to our surgery environment and its practices and by supporting a compassionate approach to patients with dementia.

What challenges are currently experienced by people with dementia in accessing our practice?

People with dementia can struggle with:

 Remembering to attend appointment,s

Navigating the physical environment of the practice,

Expressing their concerns in the short time available with the GP, and

Recalling details of discussions regarding their care.

This can result in missed appointments, repeat appointments, and people not getting the support and care they need to live well and manage dementia and any co-morbidities. This impacts not only on quality of life and health for the person with dementia now and in the future, but can also have an impact on usage of primary care, emergency admissions to hospitals, and transition to residential care.

Patients with dementia also need:

 Information on support available, and

Reviews of their care (including their medication) as needs change.

Changes we will make to better support people with dementia:

1. Improve the environment

People living with dementia can find it difficult to read everyday signs and may require additional help to find their way around. Having dementia friendly signs, which include symbols and pictures, can be easier for people to understand.

We will:

Use dementia friendly signs

Have a dementia friendly clock in the waiting room

2. Accessing Appointments

People with dementia can struggle to remember to attend appointments. Having an easy-to-use appointments system and sending reminders to patients or their carers can help to reduce missed appointments. Communication and understanding is often an issue for people living with dementia. It can sometimes be difficult for patients to recall past discussions regarding their care, so offering double appointments can give people extra time to express themselves.

We will

Ensure continuity of care by offering appointments with a preferred named GP

Assist patients in identifying which GP they usually see

Ensure that appointments can be booked in person at the reception desk, by telephone or online, by a patient or by their carer on behalf of the patient

Offer appointment cards or diary stickers

Offer a pre-appointment telephone call if required

Offer double appointments at the discretion of the GP

Come out to the reception desk with the patient to ensure that follow up appointments and arrangement for tests are made.

3. Good Clinical Practice

We will:

Maintain a dementia register

Ask about symptoms of cognitive impairment during chronic disease management review and medication review.

Offer screening blood and urine tests to patients who have concerns about cognitive impairment.

Check for Anti-Cholinergic Burden (ACB score) at medication review of patients who have concerns about cognitive impairment or who have a diagnosis of dementia

Be mindful of Anti-Cholinergic Burden (ACB score) when prescribing at for patients who have concerns about cognitive impairment or who have a diagnosis of dementia

Offer memory clinic referral to patients who have concerns about cognitive impairment.

Encourage patients with a diagnosis of dementia to be involved in their care and contribute to a care plan/advanced care planning.

Put procedures in place to obtain consent to involve carers as appropriate.

Offer twice yearly reviews to patients with a diagnosis of dementia, reviewing their general health, their medication (including Anti-Cholinergic Burden, ACB score) and their care plan/advanced care plan.

Offer signposting and access to information via the Bromley Dementia Hub.

4. Increase dementia awareness for all staff

It is important that staff (clinical and non-clinical) are able to spot when patients have dementia. Regular awareness training for staff will help staff understand what information and support people need to manage their condition.

We will

Identify a Dementia Champion

Ensure all our staff undertake regular dementia awareness training via Blue Stream Academy and the Alzheimer’s Society Dementia Friends programme, and update this at least every three years

5. Better community engagement

By listening to people from every part of the community, services can understand what patients with dementia and their carers need.

We will:

Aim to include patients with early cognitive impairment or their relatives or carers in our Patient Participation Group

Join our local Dementia Action Alliance

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

Please see above

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