iSPACE is a quality improvement and innovation programme delivered in GP surgeries in all parts of Hampshire, Dorset, Isle of Wight and south Wiltshire. The aim of iSPACE is to improve the pathway of patients with dementia and their carers through primary care. The key to the spread of iSPACE is the engagement of staff teams and a recognition that people with dementia need a more personalised care plan and access to resources to help them and their carers to better manage the pathway.
Wessex AHSN worked with Alzheimers charities, clinical commissioning groups (CCGs), Public Health England (PHE), Health Education England (HEE) and companies providing dementia services both within and outside the NHS to deliver this project. The AHSN delivered the project into 153 GP surgeries providing training, access to resources, meetings to encourage progress and physical resources such as funding for environmental changes and literature.
Patients reported feeling more supported by their surgery; carers reported a greater understanding of dementia from the surgery team and seeing the same clinician at each appointment. Dementia diagnosis rates increased (15.9% for people aged over 65), care planning increased by 26% for face to face reviews and 80% of surgeries now have a dementia noticeboard.
“The iSPACE programme has been a tremendous success in North East Hampshire and Farnham CCG. THE Wessex Academic Health Science Network really helped to engage local GP practices in this very valuable piece of work. Practices have reported back that it has been a very powerful process and has changed the way they work in a very positive way.”
Nick Parkin, Senior Commissioning Manager for Mental Health and Learning Disabilities, North East Hampshire and Farnham CCG
Within both primary and secondary care, patients with dementia are receiving sub optimal care. This is illustrated in the national audit of dementia care in acute hospitals (2013) and the All Party Parliamentary Group report on diagnosis in primary care (2012).
Under-diagnosis of dementia is leading to crisis situations when the person needs health or social care. Stigma still exists around this illness, preventing an open discussion and early support to people with dementia and their families.
It is estimated for 2016 that 674,345 people in England have dementia. Numbers grow annually and the growth rate is higher than average in Dorset and the Isle of Wight. Numbers are predicted to double by 2050.
iSPACE was developed from a hospital based dementia care model. iSPACE involves the surgery team appointing a champion and then pursuing a change programme with actions in five main areas, staffing, processes, environment, assessments and care planning. It was piloted in two sites and then evaluated to assess the impact.
Wessex AHSN contacted surgeries across the region and encouraged them to adopt the programme. Training was offered to the staff team along with access to all the resources needed to complete the project. The project started in April 2014 and by May 2017 over 50% of the surgeries in Wessex had engaged with the project.
This has now resulted in 153 surgeries achieving the accreditation, and the project has now been mainstreamed to the CCGs across Hampshire, Dorset, south Wiltshire and the Isle of Wight.
As a result of implementing iSPACE, surgeries now have:
- Increased diagnosis rates
- Better engagement with carers
- Dementia friendly signage, iSPACE noticeboards and bespoke local services leaflets
- Care planning documents focusing on dementia and carers
- Staff trained in dementia awareness
- More annual reviews undertaken and fewer crisis consultations.
Through Wessex AHSN, every CCG in Wessex collaborated on this project and two CCGs incentivised their GP surgeries to undertake iSPACE.
Comments made by surgeries include:
“The best dementia training I have ever had – thank you.” Forestside Surgery, Hampshire
“Very client focussed and relevant to practice.” Park and St Francis Surgery, Hampshire
“Fantastic resources, tailored to our organisation, very helpful.” Manager, Crondall Surgery
Comments by patients and carers include:
“Dementia’s mentioned more, posters are up – and we see the same doctor every time.”
“This project is good – it’s what’s needed.”
Impact summary for participating GP surgeries one year after iSPACE implementation:
- 14% increase in the number of patients diagnosed with dementia
- Total staff trained is 2.4 higher (2969 people)
- Approximately one carer is identified for every two patients – 43% increase
- Each dementia patient received on average 3.3 consultations – 16% reduction
- 9% increase in patients having an annual review and 26% increase in face to face reviews
- 80% of GP surgeries have a dementia noticeboard and provide information by other means
Spread and adoption beyond Wessex
- Nine AHSNs, SCNs and universities and 12 CCGs approached Wessex AHSN to learn more about iSPACE.
- Manchester CCG and West Suffolk CCG are using this model to support dementia friendly work in their areas.
- iSPACE is featured on six national websites including Royal College of Nursing and the Academy of Fabulous Stuff
- The project was shortlisted for an HSJ Award for Compassionate Care.
- This project has been mainstreamed to the Clinical Commissioning Groups in Wessex. Dorset CCG (96 surgeries) has appointed a member of staff to support the 45 remaining surgeries to achieve dementia friendly status.
- A project evaluation was published by the Centre for Implementation Science, University of Southampton and a webinar conducted in November 2017.
- iSPACE has been submitted to the British Geriatric Society spring conference for 2018.
- iSPACE has been submitted as a national HEE resource for primary care.
- iSPACE features on the DH care planning guidance for dementia care.
- The full resources toolkit is freely available to download from the Wessex AHSN website at wessexahsn.org/ispace.
The project ran from April 2014 to May 2017 and was handed to Wessex CCGs in summer 2017.