What is being done?
The Gnosall dementia service is a primary care-based older people’s mental health service designed to:

• Improve access
• Reduce diagnosis time
• Develop value-added interventions to improve care of patients with dementia.

Patients at risk or in the early stages of dementia are identified, as well as those exhibiting signs of altered cognition or mood are referred in to the service. A dementia support worker (from the Alzheimer’s Society) visits the person at home within two weeks and completes an initial assessment, including using a variety of screening tools (Clock Test, General Practice Assessment of Cognition and Brief Assessment Schedule Depression Cards). Within a month the support worker will present the patient to an old age psychiatry consultant (in the practice, or at the patient’s home) who will undertake an examination and with input from the patient and carer will devise a care plan which includes recommendations for the management of related diseases.

New role and function
The new dementia co-ordinator role was created to provide support and assessment of patients and carers with dementia prior to their appointment with the old age psychiatrist in the memory clinic held at Gnosall health centre each month.

The objectives of the new role are to provide:

• Person?centred care, taking into account the importance of relationships, interactions and social context of the person
• Early assessment and support of patients and carers
• Collaboration with agencies including local voluntary and community groups to facilitate health education, raise awareness, and provide support.
• Key worker status for the patients, linking the patient and carer with the care plan (involving them in the decision making process), the whole of the primary care team and social services.

The worker follows an agreed managed care protocol and is supervised by the Old Age Psychiatrist and a lead GP at the Practice.

Staff have received training in the various screening tools, and all staff at the practice have received training in the new service.

Referrals are encouraged from any source, and from anyone who is experiencing changes in cognition. Within the surgery primary care vascular databases are screened for patients with cognitive decline, as well as other screening tools regularly used at the surgery.

What has been achieved?
The Service was developed by GP Ian Greaves who received the 2010 GP enterprise award for his work. Since its launch the service has reduced the diagnosis period from the national average of three years, to four weeks. Since its launch it is estimated the service has saved the NHS around £400,000 a year, mainly from a reduction is excess bed days.

The benefits of this approach include:

• An increase in the detection of dementia from 11 out of 60 (expected prevalence) to 60/60
• A proactive approach which has enabled most people to stay independent in their own home (only 2 out of 80 admitted to institutional care)
• Reduction in the time taken to diagnose dementia
• A patient held social and medical care plan facilitates hospital admission. This reduces excess bed days as it is easier to upgrade a social care plan than create a new one in hospital
• Consultants able to generate a more holistic assessment
• Medicines are reviewed by a pharmacist

For Stafford and surrounding districts the Mental health Expenditure on old age Psychiatry was 31% of the expenditure on services for working age adults, for Gnosall the expenditure was only 5% a saving of £115,560,00.

NHS South Staffordshire has rolled out the Gnosall model across the PCT area and launched the Staffordshire Memory Services in 2010/11. Memory clinics are provided, based in primary care in 10 GP surgeries, one extra care housing scheme and two local authority day centres. In July 2011 there were 13 clinics and plans to expand into more surgeries as the service picks up.

Integral to this is the dementia adviser service commissioned from the Alzheimer Society and the training for informal carers from another third sector organisation, Approach.