Memory assessment
project - Surrey Downs
CCG
Joanna Gavins
Memory assessment project
Who was involved
•
Joanna Gavins, Project Manager, Dementia Challenge Project, Surrey
Downs CCG
•
Dr Sen Kallumpuram, Consultant Psychiatrist and Clinical Lead, SABP
NHS Trust
•
3 Dementia Link Practitioners
Project introduction
Surrey Downs CCG awarded Dementia Challenge Funds
Improve low dementia diagnosis rates (43%)
Over 65s population 55,000
Specialist dementia link nurses (Band 6 OA MH)
Work with 33 GP practices
Identify early signs of cognitive impairment
Improve dementia knowledge in practices
Increase community awareness
Screen, assess, diagnose, care plan
Support and final diagnosis by Consultant Psychiatrist
Dementia link nurses care pathway
Diagnostic process
• Search GP Patient records
Initial
assessment
• Over 65s ‘at risk’
• Discuss with GP
• Invitation for assessment
206
• Comprehensive assessment
• Provisional diagnosis
• Mini cog and clock + functional
activity tests
• Further assessment by GP
• MRI or CT scan
• Full diagnosis
• Care plan
• Dementia blood screen
Screening
• Referral to secondary care
2000
6000
Diagnosis
and care plan
156
Issues addressed
Data sharing
agreement
Defining
search terms
Differing GP
systems (4)
Wording of
invite letters
Need for
consultant
DNAs
Older cohort
first
Challenges
• To meet with Practice Managers in each GP surgery
• To get buy-in from stakeholders i.e. GPs and patients
• Willingness for change
• De-stigmatise ‘Dementia’
Raising knowledge and awareness
GP
practices
• 4 GP awareness days
• GPs, Practice Nurses,
Support Staff
•
Public
•
•
4 Roadshows with
Alzheimer’s Society
Radio
Schools
Outcomes
Improved diagnosis rates
Knowledge and awareness
156 people directly diagnosed through the
project
GPs and practice staff
Referral rates high - c.25 per week
Public
Surrey Downs diagnosis rates now 72%
The next step – Dementia Data Harmonisation
• This project has helped pave the way for the Dementia Data
Harmonisation work which involves improving data quality of
Dementia diagnosis within primary care
• There is still some work to be done to change the hearts and minds of
GPs
• There are still certain surgeries not willing to participate in the Data
harmonisation work and so Clinical Leads are having to work harder
in those area
Joanna Gavins
Project Manager
KSS Strategic Clinical Network
[email protected]
kssahsn.net