iSpace News – Autumn 2016

Winter 2016

I iSPACE News

For further information on how to become a Dementia Friendly surgery, or if as a carer you would like your practice to be involved, please contact: Katherine Barbour: katherine.barbour@wessexahsn.net 07990 002106 Joanna Bazalgette: joanna.bazalgette@btinternet.com 07729 256941

iSPACE is a programme of change, initially developed by Dr Nicola Decker at Oakley and Overton Partnership in North Hampshire. It is a number of actions designed to enhance the patient experience through improvements in care planning, communications and awareness of dementia for staff in primary care settings.

Wessex AHSN has funded a project to spread the iSPACE initiative and make GP surgeries Dementia Friendly. This was piloted in Hampshire, implemented on the Isle of Wight and evaluated by the Wessex AHSN Centre for Implementation Science at the University of Southampton.

This project has shown good outcomes for patients and is now being implemented in GP practices across Hampshire, Dorset and South Wiltshire.

iSpace News –

iSPACE: Steps to Dementia Friendly iSPACE comprises a number of changes to surgery practices, such as staff dementia training, review of the care plan to make it relevant to dementia, collation of local resources and creation of a localised leaflet, changes to the surgery environment such as clear signage to toilets and exits, and information on display about dementia. All these steps help to break down the stigma that still surrounds dementia and encourage patients to come forward to seek an early diagnosis.

Carer comment

“It is a godsend that I can come down with Roger, as he won’t remember everything that was said.”

Comments from staff

“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.”

• Implement iSPACE plan• Sign up for Dementia

Action Alliance• Start Dementia patients

spreadsheet

Identify Dementia Champion

• Clinical meetings andtraining sessions

• Review Dementia QOFtemplate

• Encourage staff• Continuity of care

Staff

• Identify carers• Support carers with

information• Include carers in

appointments, treatment,referrals

• Encourage carers

Partnership

• Formal assessment• Early support after

diagnosis• Audit all codes to ensure

appropriate Dementiacoding

Assessment

• 'This is me'• Encourage patient• Awareness of natural

stages of Dementia• Identification of patients

who are progressing

Care Plans

• Lighting• Colouring• Signage• Wayfinding

Environment

Summary The comparison of general practices in Wessex one year before starting the iSPACE implementation and then during the iSPACE process generated very impressive and positive results. Data was provided by 35 surgeries which agreed to collect information before, during and after project implementation.

The Wilson Practice in Alton became Dementia Friendly in March 2016 and this has been followed up by other local practices. Chawton Park Surgery and Watercress Medical’s Mansfield Park Surgery in Medstead are both on track to join The Wilson Practice soon. Their enthusiasm is infectious! If your surgery has the iSPACE bug, please contact us to support you through the process.

Dementia Friendly surgeries: Wessex roundup

Poundbury Doctors Surgery, Dorchester, became Dementia Friendly in December 2015 Jane Goodson, practice manager at Poundbury Doctors Surgery, said, “Eight months later, I’d just like to say how useful the staff felt that their dementia training was. They have certainly put it to use with regard to helping patients on a day to day basis and looking out for ‘signs’ without drawing attention to the situation. Staff are also about to receive training in telephone scamming awareness where the elderly/vulnerable are being targeted.”

Penny’s Hill Practice in Ferndown, Dorset, celebrated their accreditation as a dementia friendly surgery in August 2016 with morning tea and cakes with patients and carers, together with representatives from Ferndown's dementia friendly community.

The surgery has been very committed to achieving the recognised status, working with Dorset’s iSPACE team, Joanna Bazalgette and Sue Sparkes.

They are supported by a very involved Patient Participation Group who also came along to enjoy the tea and cakes and admire the symbolic forget-me-knots, handmade by Dr Emma Richards, one of the GPs very much involved with the accreditation.

Hill Lane Surgery, Southampton Practice manager, Paula Smith, says of iSPACE, “It has revolutionised the annual review. We used to just do blood pressure, weight and it felt like a tick box exercise. Now we have This Is Me’, we take details of the carer and give information about local services. Doing iSPACE has tightened up our system and improved our care.”

The doctors at Hill Lane are ready to use This is Me if a patient with dementia has a consultation – this photo was not staged!

Dementia Friendly stories: Canford Heath Practiceby James Leyland, Practice Manager

We had been hoping for some time to make ourselves a Dementia Friendly surgery and so when we heard about the ‘iSPACE’ tool we were intrigued as to how we could implement this in practice.

Becoming Dementia Friendly felt like a daunting task before Joanna visited us, but after she started talking us through what we needed to do it all seemed so straightforward and completely obvious! We wondered why we hadn’t done it years ago.

Joanna kindly came along to our Protected Learning session and gave her dementia talk to the whole staff, including the GPs. It was informative, funny, endearing, engaging and simply marvellous! By the end of the talk everyone said how wonderful it was and it further enhanced our determination to become Dementia Friendly.

We are currently in the process of looking at our signage, putting differently coloured loo seats in place and having pictures of our GPs up on the wall to direct patients to where their consulting rooms are.

We’re putting up a dementia notice board and from the information Joanna provided we will soon have a new central point for everyone to look towards for dementia information.

After Joanna’s talk one of the receptionists was inspired to become our dementia champion and we are in the process of supporting him through the process. It will be his responsibility to ensure that everything we do is Dementia Friendly.

We are taking small steps, but thanks to Joanna and the iSPACE tool we feel far more empowered to help our dementia patients get the very best from our practice.”

Before and after

Signage on the toilet doors at The Quarter Jack Surgery, Wimborne

Smart refurbished toilets at West Moors Group Practice

A Carer’s Perspective:

VVeronica in North DorsetQ. How long have you beenregistered with your GP?

A. I have been registered for 38yrsand Christopher 23yrs. I was widowedbefore I married Christopher.

Q. How long is it since diagnosis?

A. 8 years.

Q. Can you tell us about yourexperience of Christopher’s diagnosis?

A. Christopher was having funny turnsand we spent two years previous todiagnosis going to specialists, we hadprivate insurance then. Finally he wassent to Southampton Hospital for threedays and was finally diagnosed after manyscans and checks by Mr McMonagle. He isnow under Dr Kipps. They have alwaysbeen wonderful and we look forward toour annual visit. Christopher narrowlymissed being included in a researchprogramme that he would have been onfor a year but the criteria were too tight.

Q. What was your GP’s response to thediagnosis?

A. We went to our then GP a few monthsafter diagnosis about another matter. Hesaid nothing at all relating to the diagnosisof a terminal, degenerating, incurabledisease that Christopher has. Christopherwas very upset at the time. I checked afew years later that his diagnosis was on

the screen and the GP was prescribing Aricept. No advice or information was given.

Q. Do you feel you were dealt withsympathetically?

A. Yes, at the hospital we were, but notat the GP practice.

Q. What would have improved the wayyou were given your diagnosis?

A. We should have had a meeting withour GP or a memory advisor to be giveninfo and help. This was 8 years ago; I’msure things have changed.

Q. Were you given any informationabout local services?

A. We were given no info about anythinguntil I rang the Alzheimer’s Society whotold me about the memory café inShaftesbury. There I met the MentalHealth Team that helped to run it withthe Alzheimer’s Society. So we then cameunder them and they came every fewmonths to monitor the pills. When thiswas all changed we fell between stoolsand only discovered a memory advisorrecently having asked the Alzheimer’sSociety why there weren’t any!

When in dire straits I ring Liz who works for the CMHT. And of course Elizabeth Bartlett’s group (The Laverstock Memory Support Group) is a fount of information and support, but we waited two years for there to be room for us, having seen Elizabeth speak at a conference.

Q. How easy is it to see the sameGP/nurse for each appointment?

A. You ask to see a doctor that youchoose or who you can get anappointment with. We found recentlythat our registration had been moved to adoctor we had never met and when wewent to see her, which she hadrequested, she looked at her watch andhad not read her screen at all and forgotto take Christopher’s blood pressure. Shehad no idea of our circumstances.

Q. Do you feel that there is adequatecommunication between health careproviders?

A. That’s difficult to answer as we seeso few. Southampton always sends areport to our surgery. I have now checkedthat I have Carer on my screen which Ididn’t have previously. When I said to adoctor I was in a bit of a hurry as I was acarer she asked if I was looking after mygrandchildren!

Q. Has there ever been a specificsituation which you feel could have beenhandled better?

A. After we came under the mentalhealth team we were sent to apsychologist. As we walked in, he said toChristopher, “And what is wrong withyou?” We wrote a letter of complaint andnever saw him again.

Q. Do you feel that the community youlive in could be considered DementiaFriendly?

A. No, I don’t think so, although anybodywe know - like the bank staff,optometrist, garage, chemist, postman -those that know are extremely helpful.

Q. Has your own GP practice beenaccredited by iSPACE as a DementiaFriendly Surgery?

A. No. I’m sure some of their difficultiesare that they have just become a lotbigger joining with another surgery. Alsoa lot of the doctors are part time. There isalso no Dementia doctor, whichconsidering the extent of the disease issurprising.

A friend who attends Elizabeth’s group, who is with the same practice, has the same problems as us.”

Veronica adds, “When my first husband had cancer we had our own doctor and clinicians, who were friends, and they popped in here to see us.

I know it was a long time ago. But that is why we are on the Appeal Board for the Alzheimer’s Society as we need to raise a lot of money for care and research, and importantly for post diagnostic support.”

Our sincere thanks to Veronica and Christopher for sharing their experiences with us.

Wessex clinical update

iSPACE – 27 surgeries have completed the process to become Dementia Friendly and 101 are in progress. The project will continue for a further two years and aims to reach 75% of all surgeries in Wessex – there are 312 in total. Data about diagnosis rates, care plans and identification of carers is being collected and people with dementia and their carers are doing walkabouts in surgeries.

http://wessexahsn.org.uk/programmes/3/dementia

Acute care development programme – this has resulted in seven hospitals adopting John’s Campaign. Three dementia champion conferences were held in Winchester, Bournemouth and Salisbury and frontline staff benefited from these events. Action cards were completed and these are being reviewed to assess impact.

Bournemouth University has conducted an evaluation of the programme. You can read the report on the Wessex AHSN website athttp://wessexahsn.org.uk/programmes/3/dementia.

Watch our film about John’s Campaign http://wessexahsn.org.uk/videos/show?tag=Dementia

National news

In March 2016 the Implementation Plan for the Prime Minister’s Challenge on Dementia 2020 was published.

Complementing the NHS Five Year Forward View, this plan sets out the crucial enablers which need to be implemented in the next two years in order to meet the 2020 Dementia Challenge.

Areas of focus include risk reduction, health and care, post diagnosis support, awareness and social action and research.

The full implementation document can be found on the Department of Health website at this address:

www.gov.uk/government/publications/challenge-on-dementia-2020-implementation-plan

Thank you for reading. If you’d like to be featured in our next issue, please send your updates to us via the contact details on page 1. We look forward to hearing from you!