“A diagnosis provides a gateway to ensure that people with dementia in care homes receive person-centred care. DeAR-GP provides a valuable resource to enable better integration between health and social care support; assisting care home staff, GPs and importantly those living with dementia and their family to access information, advice and support.”
George McNamara, Head of Policy and Public Affairs, Alzheimer’s Society

Overviewdear gp

Co-designed by the Health Innovation Network, The Dementia Assessment Referral to GP tool (DeAR-GP) supports care workers in care and nursing homes to identify people who are showing signs of dementia and refer them to their GP for review, which can significantly increase diagnosis rates in care homes. Once completed, DeAR-GP acts as a communicatio
n aide between care workers and GPs.

The Health Innovation Network developed and trialed DeAR-GP with care workers in care homes. The Health Innovation Network conducted a feasibility study, which demonstrated that care workers found the DeAR-GP case-finding tool easy to use. 20 out of 23 (87%) of residents reviewed using the tool were either diagnosed with dementia or referred for further assessment.

The result is a one page form that includes a behavioral observation chart, an Abbreviated Mental Test, and a pro-forma referral letter to the GP. The accompanying DeAR-GP user guide provides a step-by-step process of how to implement the tool in care homes.

The Alzheimer’s Society estimates that up to 80% of residents in care homes have dementia (Alzheimer’s Society, 2013), but a significant number of these individuals may not have a diagnosis. Dementia diagnosis supports person centred care planning and helps understanding between care workers, family members and friends; facilitating better care and support of people with the condition.

Challenge/problem identified

  • The Alzheimer’s Society estimates that up to 80% of residents in care homes have dementia (Alzheimer’s Society, 2013). The disparity between this estimate, and the number of individuals with an actual diagnosis, means that residents are not given the opportunity to make informed choices and receive well-informed person centered care, including accessing appropriate treatments and
    interventions.
  • One of the aims of the Prime Minister’s ‘Challenge on Dementia’ is to improve dementia diagnosis rates (Department of Health, 2012a).
  • Evidence suggests that early diagnosis of dementia can save up to £6,254 per person.
  • The Health Innovation Network has developed the DeAR–GP tool and user guide. It is free to download and cheap and easy to use. Care workers need minimal training.
  • The DeAR-GP user guide discusses consent issues, mitigating adverse patient impacts.
  • DeAR –GP user guide clearly states how to implement DeAR –GP including identifying the key stakeholders to engage, to mitigate any risks.
  • There are 11,250 residents in older people’s care homes in south London, in the area covered by the innovation.

Actions taken

  • The Health Innovation Network conducted a feasibility study to increase diagnosis rates in residential and nursing homes using a similar approach to the ‘Find, Assess, Investigate, Refer’ CQUIN programme for use in the acute care sector.
  • A case-finding tool was co-designed with care workers from four care homes. We explored their attitudes towards identifying people who may have dementia, their relevant knowledge and their views of various formats of a case-finding tool.
  • Care workers tested the case-finding tool in three care homes over a three-week period and used the tool with residents who they believed showed signs of possible dementia, but who did not have a diagnosis.
  • Completed case-finding tools were reviewed by a GP or a Specialist Memory Nurse (SMN), so that they could either confirm or rule out a diagnosis or decide on the necessity of further assessment.
  • The Health Innovation Network have promoted DeAR-GP widely in south London and supported implementation.

Impacts / outcomes

DeAR–GP supports the National Institute for Health and Care Excellence Dementia: Health and Social Care Quality Standard 2: People with suspected dementia are referred to a memory assessment service specialising in the diagnosis and initial management of dementia. (NICE QS1 June 2010)

Care workers demonstrated that the case-finding tool (DeAR-GP) was easy to use and that they felt confident in using it. One carer commented that she thought the tool was a positive development because it empowered her to say what she had already known; that some residents appear to have undiagnosed dementia. The Specialist Memory Nurse said that the tool was “most helpful” and saved him time because care workers had already identified residents showing signs of dementia prior to his arrival.

Care workers completed 23 case-fiDeAR-GP 2nding tools during the feasibility study. On review, clinicians diagnosed 12 residents with unspecified dementia and referred three to memory services. Furthermore, five were found by the clinicians to already have a diagnosis, which was unknown to the care homes. No further action was taken with one resident who had a normal cognitive score when assessed by a clinician, and two were not reviewed by the clinicians because they were physically unwell at the time of review. In total, 20 of the 23 (87%) care home residents who were reviewed using the tool were either diagnosed with dementia or referred for further assessment.

Lewisham CCG and Croydon CCG are currently rolling out DeAR- GP. The HIN also commissioned Bromley and Lewisham Mind to deliver DeAR- GP training to 40 care homes, covering 12 CCGs and local authorities, alongside Barbara’s Story Training in south London from April – Nov 2016.

The Health Innovation Network is delivering a joint project  with UCLPartners AHSN to deliverDeAR-GP DeAR –GP training to a further 24 care homes in north London and 12 care homes in south London by June 2017, alongside Barbara’s Story training and Join Dementia Research. The HIN also worked with Humber and Yorkshire Clinical Network  to partner DeAR-GP with DiADem.

DeAR-GP been endorsed by the National Clinical Director for Dementia and Mental Health in Older Adults, Alistair Burns, who has commended its use to all CCGs. The DeAR-GP resource on the HIN website has been visited 1,817 times, and it is now also available on the Alzheimer’s Society website.

“We know that missed diagnoses in care homes are a major reason why diagnosis rates are low in some areas. The Health Innovation Network’s ‘DeAR-GP’ empowers care workers to identify care home residents living with memory problems for review by their GP.”
Dan Harwood, Clinical Director, London Dementia Strategic Clinical Network

Plans for the future

Building on the success of DeAR-GP and the recognition that two thirds of people with dementia are living in the community in their own home, the Health Innovation Network is shifting its focus to adapt DeAR-GP for other community health settings, including sheltered and extra care housing. The results of this feasibility work will be available in autumn 2017.

Meanwhile the DeAR-GP User Guide for Care Homes will remain a free resource. The second iteration of DeAR-GP will also be built upon, to include collecting patient feedback.

Which national clinical or policy priorities does this example address?

  • Care and quality
  • Funding and Efficiency
  • Health and Wellbeing

Start and end dates

  • DeAR-GP feasibility study commenced 2014, User Guide was published 2015.
  • DeAR-GP 2 commenced in 2016, with an estimated end date re publication, of autumn 2017.

Contact for help and advice

Rebecca Jarvis, Programme Director Healthy Ageing, Health Innovation Network
E: rebecca.jarvis4@nhs.net

Find out more

Access the tool from the Alzheimer’s society website