Early interventions and diagnosis Dr Nick Cartmell SWDP GP lead for Peninsula area

Commissioning MAS Challenges facing commissioners: Rising demand Rising costs Secondary care models are manpower and time heavy Prevalence isn’t rising that much

Commissioning MAS Models of MAS: Secondary care accredited Secondary care not accredited GPs do it alone GPs do it with support (see later) GPwSI does it

Commissioning MAS Factors we need to seriously consider: Guidance from NICE, NDS, RCPsych Quality of any service model: –Reliable (subtyping, exclude other causes, MCI) –Appropriate –Acceptable to patient, carer, professionals –Prescribing issues –Care planning/monitoring thereafter

Jane Bridger’s toolkit –Case finding –How to progress a suspicion –Overcoming barriers Map of Medicine GP education programmes MAS commissioning toolkit (DoH) Toolkits for primary care

Clinical domain points rise –26 available in total –Now need for tests at time of diagnosis –Annual review QOF new QP domain –Additional incentive to developing chronic disease care pathways: dementia is IDEAL! –Pathways can be local for local needs QOF Potential

What do we do then? GPs are calling for more dementia management support in the community. Models are being looked at: DoH Demonstrator sites Advisor model HCA model Admiral nurse model Care co-ordinator within OPMHS model

Support worker Focussing attention on support worker provision has the power to: Improve earlier identification/prevalence Improve patient/carer satisfaction Reduce acute trust admissions/lengths Reduce need for OPMHS input Improve GP performance with dementia Satisfy many areas of NDS