This report summarises the findings from a series of visits carried out by NHS England’s National Clinical Director for Dementia, Alistair Burns supported by the team of NHS Improving Quality (Anne Wilkinson, and Susie Peachey) and the Memory Services National Accreditation Programme (MSNAP).
The visits were to a number of memory services which were experiencing longer waiting times from referral to assessment. The audit found that there had been significant successes in a number of clinics in improving access times over the past year, often in challenging circumstances.
The diagnosis of dementia is the key first step in the dementia pathway. Several things can help increase the number of people receiving a diagnosis, enabling them and their carers to access vital post diagnostic support. These include raising public and professional awareness, enhancing the skills of colleagues in primary care, in particular General Practitioners (GPs), and shared protocols with specialist providers. With the increase in the interest in dementia and the need for high quality services, memory services have an important role to play in the assessment, diagnosis and management of people with suspected dementia.
Waiting times from referral to assessment and diagnosis vary and the 2013 English National Memory Clinics Audit demonstrated that although three-quarters of clinics were seeing patients within 6 weeks of referral, waiting times sometimes extended to months.
Common features of the services which were reducing waiting times were:
- Reviewing the assessment pathway and reconfiguring workforce to match demand. Some achieved this through upskilling existing staff, using vacancy funding creatively or investing in new staff
- Developing joint clinical protocols for referral and diagnosis, follow-up care, access to and reporting of scans and care home management
- Supporting memory services in primary care
Based on the findings the top ten tips to service improvement are:
- Involve service users and carers at every step
- Understand current and future demand and map against available capacity
- Review referral protocols
- Review brain scan (CT/MRI) protocols
- Examine DNA rates
- Ensure correspondence clearly states diagnosis and accompanying ‘Read Codes’
- Identify education and training opportunities
- Consider protocol for diagnosis in primary care including care homes
- Review with commissioners the role of specialist nurses
- Become MSNAP accredited and share best practice examples (on MSNAP or NHSIQ websites).