1. Creating Dementia Friendly Surgeries:
A Systematic Approach
Mrs Katherine Barbour, Dr Nicola Decker & Dr Emer Forde
Background
Dementia remains one of the biggest global health challenges of our generation and one of the major causes of disability and dependency in older people (WHO, March 2015). The National Dementia Strategy emphasised the importance of creating ‘dementia friendly communities’ and this was spearheaded by the Department of Health in A dementia friendly community understands the impact of dementia on the person and their family. It provides an environment in which people with dementia can live well and feel valued. This is important because the impact of social isolation on physical health and psychological wellbeing is well established and a recent report from the Alzheimer’s society reported that 2/3 people with dementia who live on their own feel lonely.
GP surgeries also need to be dementia friendly. In 2014, Dr Nicola Decker developed iSPACE as a systematic approach to creating a more dementia friendly environment within her surgery (Oakley and Overton Surgery, North Hampshire). Following the success of this pilot, Wessex Academic Health Science Network has been promoting iSPACE within GP surgeries across Dorset and Hampshire.
iSPACE
iSPACE provides a systematic way of ensuring high quality care to people living with dementia. For example, it includes training for all primary care staff, review of care plans, collating information about local resources, making environmental changes to the surgery such as clear signage to the toilets and information on display about dementia. All these steps help to provide a welcoming environment and break down the stigma that can surround dementia. This can encourage patients who are concerned abut their memory to talk to their GP and, when appropriate, obtain a timely diagnosis and the subsequent support.
To date, 28 surgeries have completed the iSPACE process of becoming ‘dementia friendly’ and101 are in progress.
Some practices have made small changes that have improved their patients’ experiences, and others more significant changes. Examples include encouraging carers to accompany patients to appointments when appropriate; drop-in coffee mornings for carers; inviting third sector organisations to offer drop-in ‘enhancing quality of life’ sessions and set up table in waiting room with information about local services; improved signage around surgery (way out, toilets); red toilet seats; double length appointments; phone calls to remind patents who live alone of their appointments.
Impact
In Wessex it is estimated that dementia costs the NHS £180 to £200m per annum and these costs are predicted to rise by 2/3% per annum as the numbers living with dementia grows. Our initial analysis indicates that when surgeries introduce iSPACE it can reduce clinical consultations by 6% and increase in diagnosis rates by 24%. More carers have been formally registered and more active care plans are in place. People living with dementia are also engaging with the project are contributing to the spread of iSPACE.
Feedback from GP surgeries
“There are a lot of quick wins that make a real difference to staff and patients”
“We found we were already doing a lot of it – it was about bringing it all together to help raise awareness.”
“It is a godsend that I can come down with Roger as he won’t remember everything that was said”
Carer comment (after carers encouraged to attend appointments too)
For a video on the iSPACE pilot at Oakley and Overton, see
For more information contact Katherine Barbour, Senior Project Manager, Wessex Academic Health Science Network .
@WessexAHSN