Dementia DES 2015-16 "High Quality Care for All, Now and for Future Generations"
Dr Sara Humphrey GP Westcliffe Medical Practice GP with a Special Interest in Older People-BTHFT Clinical Specialty Lead Older People & Stroke Bradford District & City CCGs GP Advisor Yorkshire & Humber Dementia SCN 1/7/15
Dementia DES 15/16 This is the ORIGINAL screening DES which we have signed up to for the last 2 years
Dementia DES 15/16 This enhanced service has been designed by NHS England to reward GP practices for undertaking a proactive approach to the timely assessment of patients who may be at risk of dementia. The DES has been rolled forward to 2015/16 We need to ask the same group of at risk patients about their memory but we have excluded the patients asked in 14-15
Aim of the DES a) identify patients at clinical risk of dementia; b) offer an assessment to detect for possible signs of dementia in those at risk; c) offer a referral for diagnosis where dementia is suspected; and, d) support the health and wellbeing of carers for patients diagnosed with dementia. e) Offer all newly diagnosed patients an advanced care plan
What is new for 15/16 This year NHS England have also added in COPD patients over 60 yrs and those aged over 60 yrs at high-risk of CVD How have we defined at risk of CVD Those on a Statin for primary prevention who also have a QRISK > 20% already recorded on their notes -Those people who are invited in for an NHS health check
DES Sign up as at 2 nd July CCG No. of practices signed up to DES Total no. of practices % sign up AWC 17 17 100 Barnsley 37 37 100 Bassetlaw 12 12 100 Bradford City 27 27 100 Bradford Districts 41 41 100 Calderdale 25 26 96 Doncaster 43 43 100 East Riding CCG 34 37 92 HRW 21 22 95 HaRD 17 18 94 Hull 38 57 67 Kirklees 66 68 97 Leeds North 27 28 96 Leeds South & East 43 43 100 Leeds West 37 38 97 NE Lincs 27 30 90 N Lincs 17 21 81 Rotherham 36 36 100 Scarborough & Ryedale 14 15 93 Sheffield 87 87 100 Vale of York 28 30 93 Wakefield 36 40 90
What is the new risk category doing to the numbers Example: Practice A Total Population 11,322 Known Patients with Dementia 103 Prevalence 84.2% No. included on Dementia DES work to do list = 840 No. on list due to high-risk CVD = 181
Tools to support the implementation An Organisational Group in import tools Technical Guidance in each search/template Dementia DES searches and reports Dementia DES template Carer Template Advanced Care Plan Template Mental Capacity Act Template
Sign up to YHCS resources as at 1 st July NHS Airedale, Wharfedale and Craven 4 NHS Barnsley 3 NHS Bassetlaw 0 NHS Bradford City ALL* NHS Bradford Districts ALL* NHS Calderdale 4 NHS Doncaster 7 NHS East Riding of Yorkshire 8 NHS Greater Huddersfield 5 NHS Hambleton, Richmondshire and Whitby 4 NHS Harrogate and Rural District 10 NHS Hull 7 NHS Leeds North 3 NHS Leeds South and East 4 NHS Leeds West 1 NHS North East Lincolnshire 4 NHS North Kirklees 8 NHS North Lincolnshire 5 NHS Rotherham 5 NHS Scarborough and Ryedale 0 NHS Sheffield 15 NHS Vale of York 6 NHS Wakefield 6
Dementia DES searches and reports Practices can download searches from the CSU These identify the high-risk patients, add a reminder on the home screen and a link to the template The Work to do can then be monitored under Clinical Reports Switch off SystmOne alert
Dementia DES template
Carers template The GP practice will seek to identify any carers of a person with dementia identified in this way (where that carer is registered with the practice) and offer a carer s health check GPs may be asked to do a Carer s assessment for a patient with Dementia on another practice s list
Advance Care Plan Template We also have to undertake an ACP on all new Dementia Patients (diagnosed > April 14) It is suggested you give the ACP document to the patient and family to consider and then invite then in for a guided discussion and to record the summary details on the template
Thank You! sara.humphrey@bradford.nhs.uk (Clinical Guidance) Paula.woodrow@nhs.net (Technical Guidance) Penny.kirk@nhs.net (Implementation & roll out)
Any questions?