Dementia patient care in general practice
Improving the quality of dementia patient care in general practice
The approval of dementia as a Clinical Priority in 2012 coincided with the launch of the Prime Minister's Dementia Challenge. This set out an ambitious programme of work to radically improve the quality of life for people living with dementia, their families and carers by 2015.
The Challenge focused on three key areas:
- Driving improvements in health and care
- Creating dementia friendly communities that understand how to help
- Better research
As well as improving the quality of care, focus on these three areas is helping to reduce future pressures on the NHS and social care notably through improved recognition of dementia. In 2012, only 42% of people predicted to have dementia had actually received a diagnosis; an important aspiration of the Dementia Challenge was to improve the diagnosis of dementia to 67% by 1 April 2015. This will mean that there will be 160,000 more people with a diagnosis of dementia who will need support.
Additionally, the Dementia Clinical Priority coincided with the most extensive reorganisation of the structure of the National Health Service in England to date, the Health and Social Care Act 2012. This resulted in primary care assuming the lead role in commissioning, and the formation of other new organisations. This backdrop framed the activities of the dementia Clinical Champions with the necessity to:
- Represent the College in a broad range of arenas where strategy and guidelines for improved recognition and care of people with dementia and support for their family and carers was being discussed.
- Provide training and guidance on dementia care throughout the 'dementia journey' to support primary care with the major role it plays in the co-ordination of care of this patient population and their carers.
We have contributed to important areas and publications, such as the Management of Behavioural and Psychological Symptoms of Dementia (BPSD) and the Cognition Toolkit. These documents illustrate how management frameworks using the appropriate tools and reviews can support improved recognition and management of BPSD and improved identification of people whose cognitive impairment merits further evaluation.
Efforts to support education and training have included the well-attended Dementia One Day Essential Events in each year of the priority. There have been other major contributions such as the development of BMJ learning resources that have covered diagnosis, carer needs, end of life care and management of co-morbidities.
We have significantly contributed to the piloting and development of the University of Bradford sponsored 'Practitioner: specialist interest qualification in dementia', the Dementia Primer for general practice and the GPwSI dementia core curriculum / competencies. Alongside this, we have established and contributed to the National Working Group on the End of Life Care.
At a national level we have made a major contribution to strategy and policy. We have enjoyed support and close collaboration with NHS England, especially from Professor Alistair Burns, Clinical Director for Dementia, and the team at Department of Health, as well as Alzheimer's Disease Society, Dementia Action Alliance, International Longevity Centre, National Association for Primary Care, NICE, Public Health England and Skills for Care. Through our involvement the College has been recognised as one of the named contributors in the final strategy and guidance documents that are the output of these groups.
Currently we are lending expertise in our respective regions to support the national effects to improve dementia diagnosis rates.
Last but most definitely not least, we have engaged with technology to develop the Dementia Roadmap concept. This is a web-based platform that hosts national and local information for clinicians, patients and carers about dementia care. It has been rolled out across 12 localities and described as key to progress to supporting care, support and research in the Prime Minister's Challenge on Dementia 2020 launched in February.
Having Dementia as a Clinical Priority for the RCGP has enabled us to contribute to improved dementia recognition and care at local, regional and national levels and through our work we have been able to provide tools and training to support this. It has also helped other appreciate the important role that primary care plays in supporting patients with dementia and their family and carers through the dementia journey.