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.

The video below shows how Memory First is working in Gnosall Surgery in Staffordshire.

The service was recently awarded the £80,000 top prize in the NHS Innovation Challenge Prize for Dementia

Download a leaflet Gnosall Memory Clinic – The Basics

Service background

The Gnosall Clinic provides one half day clinic per month, with the availability of support and telephone expertise from a specialist between times.

A consultation room is available within the Practice. This is equipped with computer access and facilities for interview and routine physical examination if needed.

The clinic is organised by the Practice-based Eldercare Facilitator (ECF) who devotes two sessions per week to this work. This role was originally provided by a Health Visitor.

Specialist expertise is provided by a consultant psychiatrist with experience of work with older people and with particular interest in dementia.

People appropriate to the clinic are identified by clinicians within the Practice. This may be as a consequence of observations during routine clinical contact or attendance at screening or monitoring clinics for ‘at risk’ groups. The Clock Drawing Test and BASDEC schedule are used as initial screens for problems of cognition and mood respectively.

The clinician identifying problems, and seeking advice and help, is responsible for preparing case material for presentation to the consultant in association with the ECF.

The materials prepared for this consultation provide a basis of core information from which future actions, investigatory and therapeutic, can follow. It is important, therefore, that this is thorough but concise. The materials will be shared with the patient and, in most cases, with main carers.

The essential ‘inclusion criteria’ are interpreted flexibly: age 65 years or older, or multiple pathology, circumstances and demeanour such as are usually associated with later life. People with memory problems at any age are referred and accepted.