Primary care-led dementia diagnosis services in South Gloucestershire: Themes from people and families living with dementia and health care professionals.

BACKGROUND: Primary care-led dementia services are an increasingly common form of service delivery; however, little is known about how these services are understood by their main stakeholders: the patients, family members and health care professionals. A primary care-led dementia service was piloted in the South Gloucestershire area during 2012, in which general practitioners (GPs) led the process of assessment and establishing a diagnosis. Of the 26 surgeries in the area, 11 initially agreed to participate in the pilot, with 12 more joining the project by the end of December 2012. AIM: The aim of this study was to provide a qualitative analysis of the experiences of health care professionals, patients and their families, of the new process of assessment, diagnosis and treatment of dementia within a primary care service. METHODS: Four patients, three care-givers and eight health care professionals were interviewed by peer researchers - all of whom were current care-givers. Interviews were transcribed and analysed using thematic analysis following Braun and Clarke's model. Data were also gathered about the number of referrals and what happened to these referrals. RESULTS: Themes gathered into four main areas: 'the journey', 'what next?', 'the benefits and limits of primary care' and 'are GPs getting it right'? CONCLUSIONS: The analysis provided a perspective on the experiences of patients, family members and health care professionals involved in the relocation of part of the memory service, from secondary care (memory clinics) to primary care, being piloted in South Gloucestershire. This identified both practical issues to be improved upon as well as possible barriers.

An evaluation of primary care led dementia diagnostic services in Bristol.

BACKGROUND: Typically people who go to see their GP with a memory problem will be initially assessed and those patients who seem to be at risk will be referred onto a memory clinic. The demographic forces mean that memory services will need to expand to meet demand. An alternative may be to expand the role of primary care in dementia diagnosis and care. The aim of this study was to contrast patient, family member and professional experience of primary and secondary (usual) care led memory services. METHODS: A qualitative, participatory study. A topic guide was developed by the peer and professional panels. Data were collected through peer led interviews of people with dementia, their family members and health professionals. RESULTS: Eleven (21%) of the 53 GP practices in Bristol offered primary care led dementia services. Three professional panels were held and were attended by 9 professionals; nine carers but no patients were involved in the three peer panels. These panels identified four main themes: GPs rarely make independent dementia diagnosis; GPs and memory nurses work together; patients and carers generally experience a high quality diagnostic service; an absence of post diagnostic support. Evidence relating to these themes was collected through a total of 46 participants took part; 23 (50%) in primary care and 23 (50%) in the memory service. CONCLUSIONS: Patients and carers were generally satisfied with either primary or secondary care led approaches to dementia diagnosis. Their major concern, shared with many health care professionals, was a lack of post diagnostic support.

Using a scoping exercise to guide the development of a care homes learning network.

This article describes a project involving various stakeholders designed to develop a learning network for care homes in Bristol and the scoping exercise that gave the project team direction.