By Raheela and Kanwal
August 2015
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Care plan review every 12 months

New diagnosis of dementia
FBC, calcium, glucose, renal and liver function,
vitamin B12 and folate recorded within 6m
For all dementia reviews



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Face to face
In a timely manner throughout the year.
To devise a system which would work every
year
To be able to complete advance care plans DES
(Direct Enhanced Services)
System one search march 2015


Total 80 patients on dementia register
66/80 = 83% patients had dementia review
completed
Last year the majority of the reviews took place
between October 2014 and March 2015 (66%)

14
12
10
8
6
4
2
0
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15




Set up a dementia recall-added on to all 80
patients, 8 per month so all reviews done by
January the following year
Standard letter devised stating dementia
review now due
Monthly search which would identify those
that are due for a dementia review and letter
sent out appropriately, visits for housebound
and nursing home patients
ACP booklet discussed in practice meeting and
agreed to be discussed at dementia review

12 patients (15%) had already had their face to
face dementia review in comparison to 3
patients (3%) last year within this time frame.
8
May-15
7
6
Apr-15
5
Apr-14
Apr-15
4
May-14
3
May-14
2
1
Apr-14
0
Dementia reviews
May-15



Better Service: Good quality reviews with
advanced care plans in place
Less stress: Reviews done in a more timely
manner throughout the year rather than MAD
RUSH at the end of QOF year
Practice: Good for CQC