WebEx: The Golden Ticket A primary care dementia model Monday 19 March 2018, 15:00-16:00

Transcription

1 WebEx: The Golden Ticket A primary care dementia model Monday 19 March 2018, 15:00-16:00 Julie Miller Focus on Dementia ihub, Healthcare Improvement Scotland

2 WebEx agenda Time Item Lead 15:00 Welcome Julie Miller 15:05 Webex tips and who's who Jane Millar 15:10 The Golden Ticket A primary care dementia model Dr Emma Costello, GP and Clinical Lead for Dementia, High Weald Lewes Havens Clinical Commissioning Group 16:00 Close Kim Grosvenor, Senior Manager Lead for Dementia Transformation, High Weald Lewes Havens Clinical Commissioning Group

3 WebEx top tips Recording the webex Line automatically muted Use the chat function for questions

4 Where are you? Click on the arrow and drag it onto the map

5 Dr Emma Costello GP and Clinical Lead for Dementia, High Weald Lewes Havens Clinical Commissioning Group o o o Kim Grosvenor Senior Manager Lead for Dementia Transformation, High Weald Lewes Havens Clinical Commissioning Group

6 The Dementia Golden Ticket - A New Model of Care Dr Emma Costello, Clinical Lead for Dementia (HWLH CCG) Kim Grosvenor, Senior Manager Lead (HWLH CCG) WebEx: The Golden Ticket, 19 March :00-16:00

7 The need to change Diagnosis rate of 64.1% When people do come into contact with services it s late in the illness, too late to enable choice and usually, at a time of crisis It s an expensive approach, delivering poor outcomes for patients and carers

8 The need to Change A GP s Perspective Historical treatment and management in Secondary Care Disempowered with little or no access to training and education GP Annual Review, not fit for purpose Concentration on physical health issues General perception of what s the benefit? Confusing and fragmented Dementia Pathway No formalised Multi-Disciplinary approach 10 Minute appointment for Patient/Carer

9 Patient Case Study Mrs H (The old way of working) Multiple co-morbidities Socially isolated Losing weight Struggling with continence management Husband carer at the point of breakdown Depression and anxiety.

10 The new way of working and a new life for Mrs H Dementia Care Fellowship (Brighton and Sussex Medical School) All physical health issues treated through through the lens of dementia A Multi-Disciplinary approach, dietician, continence, community psychiatric nurse, (CPN) A point of contact in the GP practice Patient and Carer support Multiple interventions to support wellbeing and independence e.g. Yoga, singing, lunch club.

11 Any Questions? /our-programmes/dementia-golden-ticket/

12 The current picture in HWLH REACTIVE AND UNAWARE GP Referral Discharge MAS Delays Disjointed Fixed for all Medical Bias Diagnosis MCI Living Well With Dementia Where is the Patient?

13 The challenge

14 The Future model of care

15 Advice The Dementia Golden Ticket Access to Adult Social Care Timely Response GP Referral Multi-Agency Team Psychiatrist Consultant Clinical Nurse Specialist Clinical Psychologist Neuropsychologist Community Psychiatric Nurse Occupational Therapist Speech &Language Therapist Administrators Team Leader Bloods Letters PROACTIVE AND AWARE Named Team Member Assessment at Home Blip Clinic Telephone Line 12-2pm 5 days a week GP/Nurse Primary Care Review meeting: Initiation and titration of meds Social Worker Input Dementia Guide input GP phone in for individual case discussion Diagnosis at home by same Team Member GOLDEN TICKET Primary Care Reviews Dementia Guide Blip Clinics Patient AND Carer Support Well-being Interventions Advanced Care Planning

16 What does The Golden Ticket offer patients and carers? (1) A comprehensive diagnostic assessment in peoples own homes taking into account the needs of the carer A diagnosis of Dementia delivered in the persons own home by the same person who undertook the assessment A Lead GP and Practice Nurse in every Practice 45 minute Primary Care Review Meeting (within 2 weeks after diagnosis, then 6 monthly and/or annually) Weekly Primary Care Blip Clinics (of up to 45 mins).

17 What does The Golden Ticket offer patients and carers? (2) Direct Point of Contact with the Practice Nurse Information, advice and support from a Dementia Guide, (contact within 2 days and face-to-face within 10 working days after diagnosis AND part of 6/12 Review). Service is available for as long as people need it. Advanced Care Planning (supported by the Dementia Guide and signed-off by the GP) Peer Support and Carer s Café Access to wellbeing interventions.

18 1. Emotional Wellbeing 2. Physical Wellbeing 3. Memory Wellbeing 4. Occupational Wellbeing

19 Any Questions? /our-programmes/dementia-golden-ticket/

20 Testing the model of care 1 GP Practice (Buxted Medical Centre) 40 patients, living in their own home Ran from October - December 2015 Full evaluation Qualitative and Quantitative.

21 The Dementia Golden Ticket Video The Golden Ticket gave me my life back. I can go out and be myself. I have a totally different life.

22 Learning from the Buxted Pilot (1): Evaluation of Quality of Life Quality of life for patients living with dementia improved People involved felt able to live more independently There was a reported improvement in access to information and advice Wellbeing interventions were hugely beneficial to patients and carers Mental health and wellbeing improved for patients involved Carers experience and reported outcomes improved Golden Ticket workforce believed it offered an improved patient experience.

23 Outcomes from the Buxted Pilot (2): Evaluation of Primary Care 20% reduction in GP consultations 25 Blip clinic appointments during pilot, which contributed to: 25% reduction in Acute Medical admissions/a&e contacts Reduction in prescribing Reduction in falls.

24 The Dementia Navigation Handbook

25 Implementation Time-scales ( Waves ) Phase 1 (incremental implementation) Wave 1 Oct 17 Dec 17 5 GP Practices Wave 2 Jan 18 Mar 18 3 GP Practices Wave 3 Jul 18 Sept 18 5 GP Practices *Remainder of Practices coming on in Quarters until full implementation of 20 Practices Phase 2 (full implementation of MDT).

26 Make it as easy as possible Step-by-step guide for secondary care Electronic support package for Primary Care Accredited training package Clinical Templates Triage flowchart for receptionists New contracts.

27 Early Findings on impact: In first Quarter of delivery 17/18 there has been a reduction of 23% of non-elective admissions, compared to same Qtr in the previous year. This compares to only a 9% decrease in non-elective admissions in non-golden Ticket Practices. In January 2018, Golden Ticket Practices saw a reduction of 33% compared to a reduction of 12% in the non-golden Ticket group.

28 Award Winning

29 Any Questions? /our-programmes/dementia-golden-ticket/

30 Thank you