Developing an integrated care pathway

by Sue ThomasThere is currently huge interest in and awareness of dementia. This has been ignited by the publication of the National Dementia Strategy in 2009, energised by the first Prime Minister’s challenge on dementia in 2012 and fuelled by a raft of developments such as the hospital dementia scheme, the primary care detection initiative, the creation of Dementia Action Alliances across the country, reduction in the prescription of antipsychotic drugs by 50% and the creation of one million dementia friends. Support for people with dementia was rated in the top five in importance by the NHS Citizen’s Jury in 2015 (NHS England News 2 March 2016).For the last year there has been a focus from NHS England on the ambition that two thirds of the estimated number of people with dementia will have a formal diagnosis and post diagnostic support. A great deal of focus has been on primary care emphasising the long-term nature of dementia and the importance of getting care management right which includes prompt assessment and treatment. There has been much debate on whether GPs should be empowered to initiate anti-Alzheimer's medications.NHS England’s aspiration is not to persuade GPs to diagnose dementia but to facilitate information so GPs can feel safe about diagnosing dementia in certain clinical situations. There is a need to empower GPs to be able to make a diagnosis if they think that is clinically justified and appropriate.Secondly for post diagnostic care the five P’s demonstrate the advantages of investigating people with memory problems: discovering treatable emotional and Physical illness; installing Post diagnostic support for carers and families with evidence that this can Prevent crises; emPowering people with dementia and their carers; and finally Prevention of significant cognitive decline with interventions directed towards vascular risk factors.Thirdly the ability to manage a person with dementia is key and we need to ensure that the appetite for improving the care of people with dementia is ever present.New publications launched this week will help support GPs:

• Dementia Revealed: What Primary Care Needs to Know
• Dementia diagnosis and management: A brief pragmatic resource for general practitioners

Additionally the Dementia Academy is developing an integrated dementia pathway to help support practice and understanding of the requirements at every stage of the patient journey. We will be writing more on this soon.