Recognition and management of people with dementia and their family/carers in general practices in Bristol
Bristol CCG introduced a three year enhanced service for dementia in July 2013 as part of our work to shift the diagnosis of straightforward dementias from secondary care to primary care in order to reduce the wait for a diagnosis and to improve continuity of care. This service had not previously been provided by GP Practices and did not form part of their standard contract.
GPs are supported by skilled memory nurses in the community, to undertake a diagnosis of dementia, but complex cases of dementia are referred to the memory clinic.
Primary Care is supported to deliver enhanced reviews for people with dementia, over and above what is required in the Qualities and Outcomes framework. Our reimbursement is based on the clinical time required to make a diagnosis or undertake an enhanced review.
The GP Practice does not only have a key role to play in the diagnostic process, it also has an important role in following the person with dementia and their family/carers through the different stages of their condition to ensure all the support is available for the person’s ongoing management of health and well being.
Prior to the implementation of the enhanced service, we piloted this work and it was evaluated by the University of the West of England. The pilot was also a case example in NICE commissioning guide support for commissioning dementia care .
Dementia Wellbeing Service
Our care pathway has been developed around the model of putting primary care at the heart of the care for people with dementia.
To support this, we have commissioned a new service – the Dementia Wellbeing Service, provided by Devon NHS Partnership Trust and Alzheimer’s Society to fit with the enhanced service and provide even better support for GPs and their patients, especially focussing on helping people after they are diagnosed. We’ve alsointroduced the new Dementia Information Guide that includes a list of all local services.
From our evaluation of the enhanced service, the majority of the GPs now have a better understanding of dementia and feel patients are getting a quicker and more effective service.
Bristol are now national leaders in making the diagnosis and looking after people with dementia within Primary Care without the need to automatically refer every patient. Others are now following our example.