10 key steps

Educate; promote

Questions to consider

what is the ‘diagnosis gap’ in my practice?
what are the needs of people living with dementia, on my practice list?
what do our patients’ experience tell us? what do our staff tell us?
how can we improve their experience, and achieve better outcomes?
do patients and carers/families have access to the right information and support, at the right time?

DRIVER: True prevalence and diagnosis rate for GP patient registered list

Actions

Resources

Examples

Estimate true prevalence and calculate local diagnosis rate:

estimated prevalence of dementia in the community,
estimated prevalence of dementia in local care homes.

Use true local prevalence as a baseline in order to establish ‘diagnosis gap’ and local trajectories for improvement. Estimate:

local diagnosis rate
local ‘diagnosis gap’ in the community, and among patients living in care homes
patients with co-morbidities
potential needs of carers/families

Accelerating Dementia Diagnosis 2012 action plan
This plan sets out actions to accelerate dementia diagnosis across Cornwall and the Isles of Scilly. Read more »
Enhancing the early diagnosis of dementia across East Berkshire
This project aims to improve the early diagnosis of dementia by increasing the number of initial screening assessments and raising awareness about the benefits of assessment and early diagnosis as part of an overarching Aging Well campaign across East Berkshire. Read more »
Improving GP coding of dementia in London
This project aimed to find out whether it is possible to raise diagnosis rates through undertaking an exercise to ‘clean up’ dementia coding and records at a practice level. The hypothesis was that problems in GP coding may be contributing to the reported dementia diagnosis gap. Read more »
Memory First
Memory First is an integrated dementia service run by a consortium of 162 GPs across 41 practices in Staffordshire. Its pioneering joined-up approach to care has cut diagnosis times from 3 years to 4 weeks and led to major improvements in patient experience. Read more »
Primary care early detection and support services for dementia in Kent and Medway
This project will establish a primary care based model of memory assessment to increase the recognition, diagnosis and targeted case management of people living with dementia in Kent and Medway. Read more »

DRIVER: Knowledge, skills and capacity

Actions	Resources	Examples
Listen to the voices of people living with dementia.	Dementia core skills education and training framework Dementia revealed: what primary care needs to know Dementia: A state of the nation report on dementia care and support in England Kinda Magic toolkit Making involvement count Turning up the volume: unheard voices of people with dementia World Alzheimer Report 2013	Involving people with dementia in service evaluation and planning This project led by South Yorkshire Collaborations in Leadership for Applied Health Research and Care is exploring the ways that people with dementia can be better involved in service feedback, evaluation and planning. Read more » Making involvement count The resource pack is made up 18 cards each aimed at giving specific information, advice and top tips on a range of topics that will help overcome or prevent this, and support people with dementia to get involved in activities whilst recognising their current abilities. Read more » Told in South Yorkshire – life story work and people with dementia A group comprising people with dementia, carers, health and social care staff and academics are leading a programme of research and practice development around the use of Life Story Work. Read more »
Review learning needs, and build in to General Practice team development plans training and education in dementia recognition, assessment, and care.	Care of people with dementia in primary care Dementia core skills education and training framework Dementia Diagnosis Competence Map Dementia workforce portal Dementia: A state of the nation report on dementia care and support in England Diagnosis and early intervention in primary care Essential knowledge updates – dementia Report on the GP education seminar programme Royal College of Psychiatrists Alzheimer’s and dementia resources SCIE dementia e-learning programme	An evaluation of dementia support worker roles This report presents an evaluation of existing models of community-based support for people with dementia, their families and carers. Read more » Dementia diagnosis and management: a narrative review of changing practice Through the EVIDEM project, Professor Steve Iliffe and colleagues, reviewed studies of interventions to improve GPs performance in the early detection and management of dementia. Interventions proved more successful when tailored to the learning needs of the GPs and developed with them. Read more » Gloucestershire dementia strategy The Gloucestershire dementia strategy recognises the pivotal role of primary care staff, and GPs in particular, in diagnosing dementia and in subsequently co-ordinating care across a range of services. Read more » Lostwithiel nurse led memory assessment service Lostwithiel General Practice in Cornwall has introduced a nurse led memory assessment service to support detection, diagnosis, and post-diagnosis care and support. Read more » Torbay and South Devon dementia care home learning community This project aims to develop an innovative service to improve the quality of life of people with dementia through the development of a care home learning community in Torbay and South Devon. Read more »
Consider new roles, and new ways of working to support people with memory problems and a diagnosis of dementia, and their carers/families in primary care and the community.

DRIVER: Recognition and support

Actions	Resources	Examples
Ensure patients and carers/families have access to a range of information about memory problems, and dementia	Caring for Carers Dementia: assessment, management and support for people living with dementia and their carers How living with dementia could be Joint declaration on post-diagnostic dementia care and support Prime Minister’s challenge on dementia 2020 State of Caring 2017 Turning up the volume: unheard voices of people with dementia	Carers Call to Action The Dementia Action Alliance have launched the Carers Call to Action to transform the lives of family and friends caring for people with dementia. Read more » Dementia awareness resource pack This pack contains a selection of quality assured awareness raising resources designed to promote living well with dementia. The resources include leaflets, factsheets, contact lists and a DVD. Read more » Gloucestershire Living Well Handbook The Living Well Handbook has been developed to allow people living with dementia to communicate their likes, dislikes, medical and lifestyle needs to carers and healthcare staff. Read more » Post diagnosis support and information in South Gloucestershire This South Gloucestershire based project aims to share good practice and ensure that all patients and carers get equal access to post diagnosis support and information via a range of media: face to face, handbooks, leaflets, telephone and the web. Read more » Sheffield dementia information pack This pack provides a guide to the medical, care, support and advice services in Sheffield and to living well for those worried about their worsening memory problems and those with a diagnosis of dementia. Read more » Understanding dementia, training course for carers in North Hampshire This project will deliver the Department of Health approved ‘Understanding Dementia’ training course to educate carers in North Hampshire about dementia from first diagnosis through the dementia journey. Read more »
Promote and support dementia friendly communities.	Building dementia-friendly communities: A priority for everyone Dementia 2013: The hidden voice of loneliness Dementia Atlas Dementia core skills education and training framework Dementia Peer Support Resource Pack Dementia: A state of the nation report on dementia care and support in England Dementia: assessment, management and support for people living with dementia and their carers How living with dementia could be Prime Minister’s challenge on dementia Prime Minister’s challenge on dementia 2020	Bristol as a Dementia Friendly City This project aims to move Bristol towards becoming a ‘dementia-friendly city’ in which people with dementia can enjoy the same opportunities to take part in a social life, live independently and engage in everyday activity as other people, without fear of stigma or rejection. Read more » Dementia Action Alliance The Dementia Action Alliance brings together organisations across England committed to transforming the lives of people with dementia and their carers. Read more » Dementia friendly Plymouth This project aims to make Plymouth a dementia friendly city in which people with dementia can enjoy the same opportunities to take part in a social life, live independently and engage in everyday activity as other people, without fear of stigma or rejection. Read more » Dementia Health Integration Team Bristol and South Gloucestershire The Dementia Health Integration Team (HIT) is a team of professionals who are all working together to transform care for dementia patients across Bristol and South Gloucestershire through comprehensive research, integrating and improving care services, and by creating dementia-friendly communities. Read more » Dementia Resource Suite The Dementia Resource Suite contains tools and resources developed by pupils and teachers as part of an intergenerational project, to create dementia friendly communities in 22 pioneer schools across England in 2012-13. Read more » Developing a more Dementia Friendly Hampshire The project aims to establish sustainable dementia friendly communities across the county of Hampshire, reaching as full a range of different communities as possible. Read more » Making University Hospital Southampton dementia friendly This project aims to ensure that staff working in University Hospital Southampton are dementia aware and have the appropriate skills to meet the needs of people with dementia. Read more »

Dementia Partnerships

Sharing knowledge and learning across the Well Pathway for Dementia

6. Educate; promote

10 key steps

Educate; promote