850,000 people in the UK currently live with dementia – and this figure is set to rise to one million by 2021. These patients are among the most abundant and vulnerable demographics cared for in general practice. Practice Business explores how you can support them in navigating GP surgeries and appointments to create happier, healthier patients and a more efficiently managed practice
Dementia is one of the UK’s leading health problems; 7.1% of all people over the age of 65 have dementia. As such, many GP appointments will be taken up by dementia patients or by concerned family members, guardians and carers who think a loved one may be showing early signs of the disease.
GPs are the gateway to the correct diagnosis, information, guidance, medication and ongoing management for those with dementia – offering patients and their families a lifeline. Practices should, therefore, feel like safe environments designed to empower those touched by dementia so that, as the condition progresses, those affected are both prepared and supported.
However, even with the best quality care within reach, dementia patients often report feeling alienated or confused when trying to access their GP surgeries. This is no surprise; dementia can cause patients to become disorientated, to forget aspects of their medical histories and to miss appointments.
It goes without saying that practices should be dedicated to easing these obstacles to GP access in order to improve quality of life for such a large patient demographic. In The Alzheimer’s Society’s A guide to making general practice dementia-friendly, an anonymous practice manager makes this illuminating comment:
‘If your practice is geared up to, thoughtfully and respectfully, consider the needs of the patient with dementia, you will be able, almost by default, to know that you’re providing a caring environment for all those most vulnerable and in need.’
However, making your surgery more accessible to those with dementia has huge benefits for your practice, too. For example, looking after dementia patients and their carers helps you fulfil Care Quality Commission requirements, supports national frameworks and standards for dementia such as the NHS England Well pathway and the CCG improvement and assessment framework. It will also reduce the amount of missed appointments and contribute to overall job satisfaction for clinical and non-clinical practice staff alike.
Therefore, just as GPs are in the best place to offer medical advice and signposting to those with dementia, practice managers are in the perfect position to make the logistical aspects of navigating general practice easier for dementia patients.
Small changes to the way a practice and its systems function can have a huge positive impact, and many require only little time or small financial investment. Below, we explore some of the ways you can transform your practice into a more accessible environment for those with dementia.
Making appointments easier to book, attend and remember
Offer a range of appointment types to suit each individual patient with dementia. Offering double appointments can give them more time to communicate their symptoms, needs and the social effects of their condition to the GP. Telephone consultations may put patients who find accessing GP premises or waiting areas distressing or confusing at ease. Home visits to dementia patients may also be appropriate in certain cases.
Set up a system where receptionists ring dementia patients or carers on the morning of their appointment to remind them to attend. This is more effective than relying on text message reminders alone.
Using computer systems to monitor dementia patients
Log any missed appointments of those with, or suspected of having, dementia carefully, and evaluate their frequency. You can then brainstorm ideas to help these patients remember their appointments, taking ideas from the above and information from each individual case to formulate an appointment attendance strategy.
Install a computer alert system that flags up a patient’s dementia diagnosis. When they check in, the system will alert reception staff that patients may need physical assistance to get to the consultation room, or that they may need a quieter, alternative waiting space.
Training your staff in dementia accessibility
Train all practice staff in dementia awareness, with a focus on how to make the practice a more inclusive environment for this demographic. Train employees to spot the signs of neglect or abuse of people with dementia, or their carers.
Consider making your employees aware of iSPACE, a dementia-friendly primary care model established by Dr Nicola Decker at the Oakley and Overton Practice in North Hampshire. The ‘S’ stands for skilled staff; the ‘P’ stands for partnership, ensuring the collaboration of health care professionals and connecting with carers, family and friends; ‘A’ is for assessment; ‘C’ is for care plans while ‘E’ stands for creating environments that are welcoming for dementia patients.
The ‘i’ in ‘iSPACE’ stands for ‘identify’ – identify two ‘dementia champions’ in your practice, where two members of staff take on the role of ‘practice experts’ in dementia care; ideally, one clinician and one non-clinician should become dementia champions. This could be you, as practice manager, or another member of the practice team who may have particular knowledge or personal investment in helping those with dementia. To read more about the fantastic iSPACE initiative and its effects, click here.
Give all staff the Alzeimer’s Society’s practice dementia checklist to read upon induction as a guide to how all dementia patients should be monitored, cared for and treated.
Making your physical environment accessible
Ensure all signs and information are clear and ensure the entrance, waiting room, toilets and consultation rooms are clearly signposted. Similarly, make sure your waiting area environment isn’t cluttered with magazines or crammed with medical leaflets and posters.
If you have space in your practice premises, create a quiet room as an alternative waiting room for those with dementia and other patients who may find the reception area loud or distressing.
Implementing these small changes into the running of your practice can truly transform the experience of your dementia patients. With systems in place to help patients navigate your premises and attend their appointments, your practice will run more smoothly and efficiently, benefitting everyone.
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