Living with dementia magazine November 2010

Sarah Voss is a Research Fellow with the Avon & Wiltshire Mental Health Partnership NHS Trust and the six practices that have tried out the training are all in that area.

People with dementia and carers have contributed to an educational training programme aimed at boosting person-centred care and earlier diagnosis in GP surgeries.

After three years of hard work, Dr Sarah Voss has developed a training programme that can help to change the attitudes of GPs, practice nurses and reception staff to dealing with dementia.

Funded by an Alzheimer's Society fellowship grant, Dr Voss has worked with people with dementia, carers and health professionals to design, develop and test a structured training session focusing on the issues that affect people with dementia when they use primary care services.

Reluctance to diagnose

'Research shows that GPs can be reluctant to diagnose dementia. This can be due to a lack of appropriate skills or knowledge or a concern that making a diagnosis will bring little real benefit to that person.

'Our aim in delivering the training was to ensure GPs are better equipped to diagnose the early stages of dementia and that they treat and refer patients more appropriately.'

Dementia can be difficult to identify. Even people who have the condition can easily overlook its early signs and symptoms, and may even ignore or deny the changes they are experiencing.

Being proactive

The dementia awareness training promotes the idea of person-centred care. It focuses on the experiences of the person with dementia rather than just the biology of the illness.

Dr Voss says,

'This training reduces the barriers to diagnosis that exist in primary care. It helps staff to understand patient behaviour. For example, someone with developing dementia might make repeated appointments at the surgery and miss them, or attend but not say clearly what they are anxious about.'

The training helps staff to understand the need to be proactive in raising the possibility of dementia.

Primary care staff who have received the training say they feel more confident in knowing that dementia is not just limited to memory loss, but can also affect someone's state of mind and consequently, their behaviour.

Input from people with dementia

The hour-long training sessions are delivered using a printed training manual as well as slides and videos that can be shown on a computer.

Dr Voss spent many months collecting the experiences and opinions from people with dementia and those who care for them. She incorporated these into the training sessions so they include first hand accounts of what it is like to develop dementia and how a GP or others can help.

Dr Voss says,

'The video clips include people's feelings about why early diagnosis is important. They help the staff to think about dementia from an individual's point of view.'

This includes the needs of carers, who are represented as patients in their own right.Case examples also form part of the training to help the team consider the type of decisions they might make.

Dr Voss says,

'This always gets people talking and sharing ideas about people they've seen.'

The final section includes information on making referrals to memory services and what happens for patients and carers at that stage.

Tackling dementia together

Angela Brunning is the practice manager at a medical centre in Swindon, where a team of 30 staff including GPs, practice nurses, reception and administrative staff, received the dementia awareness training.

Angela says,

'It's unusual for the whole practice to attend training together. Sometimes the reception staff and doctors can feel very separate and it's good for the whole team to play a role in patient care. It's not just the doctor's job. Often we see things that they won't.'

The researchers asked the team questions before and after the training to assess its impact on their attitudes to dementia.

Since receiving the training, Angela says that reception staff have voiced concerns about particular patients to GPs. The training has also helped to raise awareness about the Society's Worried about your memory? campaign and clarified the differences between dementia and Alzheimer's disease.

Impact of training

So far, training sessions have been run in six primary care practices. Analysis shows that team members who received training have a more positive attitude to the benefits of early diagnosis and greater confidence in understanding the symptoms of dementia.

They also said they feel better equipped in identifying and managing dementia. Analysis also highlighted that staff are more likely to raise the subject of dementia with patients who are reluctant to seek a diagnosis.

Dr Voss's grant focused on developing the style and content of this training. The next stage will be to test whether it can lead to better care and earlier diagnosis by systematically measuring the difference the training makes in a randomised controlled trial.

She is now waiting to hear from the Department of Health about possible funding for the trial.