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www.england.nhs.uk
Does Dementia matter?
"High Quality Care for All, Now and for Future Generations"
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Dr Sara HumphreyGP Westcliffe Medical Practice
GP with a Special Interest in Older People-BTHFTClinical Specialty Lead Older People & Stroke Bradford
District & City CCGsGP Advisor Yorkshire & Humber Dementia CN
August 2016
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What does the Data Tell us?
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Dementia Diagnosis – North Aggregate position
=50,809
Estimated number of people still to be diagnosed (Jun)
Page 4
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• Sub-heading• Date
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Dementia Diagnosis Rates –Feb 15
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Why is a diagnosis important?
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Patients and their Carers want it!
“It was a huge relief…right thank goodness now we’ve got a diagnosis, now I know what I’m dealing with and I’ll cope with it”
“It’s an illness, it’s a terminal illness as well you know, nobody gets better from it, and it isn’t treated like that with the NHS is it, unfortunately…if it was cancer it would be different, you know”
“Absolutely instead of being really really aggravated you become empathic on diagnosis”
Source: Dementia in Leeds Evaluation Project, 2013
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Transforming ‘toxic uncertainty’ into ‘empowered understanding’
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Right to Know Campaign
• Imagine feeling ill but being told your new symptoms and behaviour were just a natural part of ageing. Imagine having a condition but no treatment, information, or support to help you manage it. Imagine if your doctor knew about your condition but chose not to tell you, as they thought nothing could be done to help.
• For many people with dementia, this is the reality. Denied a diagnosis, denied treatment, and denied the chance to plan for the future while still able to do so.
• At Alzheimer's Society we think this is wrong. We think everyone with dementia has a Right to Know. A Right to Know about their condition in order to tackle it head on. A Right to Know about the information and advice available to them. A right to be fully supported after their diagnosis. This is not a lot to ask, and only what people deserve.
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Why is Dementia important to the CCG?
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Why is it important for the NHS and LA
• We spend £23 Billion a year as a society and we can spend this money more effectively rather than on expensive crisis interventions
• Crisis presentations• Care Home Admission ( or delay them)• Reduce Emergency Admissions and readmissions to
Hospital• Reduce hospital Length of Stay• Spend the money saved on more meaningful support
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Total Estimated savings £86 million Nationally on just 4 conditions
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Also important as part of CCG monitoring
• STP• CCG Improvement and Assessment Framework• -Dementia Diagnosis Rates• -% Face to Face Care Planning Reviews
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What are the barriers to getting a diagnosis?
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GPs are one of the biggest barriers!
• NAO found that fewer than 2/3 of GPs felt it was important to actively look for early symptoms.
• GPs who completed the knowledge test had an average score of 47%
• GP attitudes to Dementia were contributing to the delays in diagnosis-there was an attitude of ‘what difference will it make’
• Only 31% felt they had enough knowledge to manage the disease.
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Why does a diagnosis make a difference?
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NHS Social Care
Care Planning to reduce admissionAdvance Care Planning/DNA CPREnd of Life CareSTOPP MedicationSecondary Prevention-vascularCPN supportResearchHospital LiaisonHospital schemes such as ‘Forget me not’
Day CareRespiteHome CareEquipmentAssistive TechnologyWork AdviseDriving SupportBenefits
Third Sector Carers
Alzheimer's SocietyAge ConcernCarers Organisations
LA Carer assessmentsPeer supportCare Health check and flu immsBenefits ( Carers allowance)Respite
ACCESS TO SERVICES & SUPPORT!
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What makes a difference?
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What makes a difference?
• CCG/Governing Body Ownership and support• Dementia Strategy Groups• Strong clinical Leadership with support• Effective Relationships with Providers• Education of GPs and Primary Care• Work with Care Homes• Clear Pathways to diagnosis & Support• Dementia part of other work steams-Self care etc• Coding Audits• High uptake of initiatives
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North of England Coding Guidance
Diagnostic description Read Code CTv3 code ICD10 codeAlzheimer’s Disease Eu00z F110. F00
Alzheimer’s Disease with early onset F1100 X002x F00.0
Alzheimer’s Disease with late onset F1101 X0030 F00.1
Vascular dementia Eu01z XE1XS F01.
Dementia in Parkinson’s disease Eu023 Eu023 F02.3
Fronto-temporal dementia Eu02y X0034 G31.0
Lewy-body dementia Eu025 XaKyY G31.8
Mixed dementia Eu002 Eu002 F00.2
Unspecified dementia Eu02z XE1Z6 F03.
Mild Cognitive Impairment** Eu057 X00RS F06.7
** Does not add patient to QOF register
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Can we correlate DQT results and monthly diagnosis rates?
Caveats• Number added to register from DQT is taken directly from practice survey submissions and has not
been quality checked• Where practices resubmitted updated survey results, older results were deleted and therefore show
later in the project findings• DQT results would show in HSCIC data in the subsequent month to when activity took place
Overall figures can be correlated showing the DQT’s contribution to reducing the register to ambition gap between October-January. However it is clear there are many other initiatives on-going which are supporting the rise in diagnosis rates
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Incentives for General Practice
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• Ref Counting the cost-Alzheimer’s Soc 2009• sara.humphrey@bradford.nhs.uk• nicola.phillis@nhs.net• Penny.kirk@nhs.net
Thank You!
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