This document provides information about the iSPACE program which aims to make general practices more dementia friendly. It discusses the steps involved in becoming a dementia friendly surgery including staff training, improving care plans and signage, and providing information to patients and carers. Feedback is provided from several practices that have implemented the iSPACE program including positive impacts on patient care and support for carers. A carer's perspective is also shared, discussing their experience of diagnosis and interactions with the healthcare system.

1. iSpace News – Autumn 2016
Winter 2016
I iSPACE News
For further information on how to become a Dementia Friendly surgery, or
if as a carer you would like your practice to be involved, please contact:
Katherine Barbour: katherine.barbour@wessexahsn.net 07990 002106
Joanna Bazalgette: joanna.bazalgette@btinternet.com 07729 256941
iSPACE is a programme of change, initially developed by Dr Nicola Decker at Oakley
and Overton Partnership in North Hampshire. It is a number of actions designed to
enhance the patient experience through improvements in care planning,
communications and awareness of dementia for staff in primary care settings.
Wessex AHSN has funded a project to spread the iSPACE initiative and make GP
surgeries Dementia Friendly. This was piloted in Hampshire, implemented on the Isle
of Wight and evaluated by the Wessex AHSN Centre for Implementation Science at
the University of Southampton.
This project has shown good outcomes for patients and is now being implemented in
GP practices across Hampshire, Dorset and South Wiltshire.

2. iSpace News –
iSPACE: Steps to Dementia Friendly
iSPACE comprises a number of changes to surgery practices, such as staff dementia
training, review of the care plan to make it relevant to dementia, collation of local
resources and creation of a localised leaflet, changes to the surgery environment such as
clear signage to toilets and exits, and information on display about dementia. All these
steps help to break down the stigma that still surrounds dementia and encourage patients
to come forward to seek an early diagnosis.
Carer comment
“It is a godsend that I can come down with Roger, as he won’t remember everything that
was said.”
Comments from staff
“There are a lot of quick wins that make a real difference to staff and patients.”
“We found we were already doing a lot of it – it was about bringing it all together to help
raise awareness.”
• Implement iSPACE plan
• Sign up for Dementia
Action Alliance
• Start Dementia patients
spreadsheet
Identify Dementia
Champion
• Clinical meetings and
training sessions
• Review Dementia QOF
template
• Encourage staff
• Continuity of care
Staff
• Identify carers
• Support carers with
information
• Include carers in
appointments, treatment,
referrals
• Encourage carers
Partnership
• Formal assessment
• Early support after
diagnosis
• Audit all codes to ensure
appropriate Dementia
coding
Assessment
• 'This is me'
• Encourage patient
• Awareness of natural
stages of Dementia
• Identification of patients
who are progressing
Care Plans
• Lighting
• Colouring
• Signage
• Wayfinding
Environment

3. Summary
The comparison of general practices in Wessex one year before starting the iSPACE
implementation and then during the iSPACE process generated very impressive and positive
results. Data was provided by 35 surgeries which agreed to collect information before,
during and after project implementation.
The Wilson Practice in Alton became
Dementia Friendly in March 2016 and this has
been followed up by other local practices.
Chawton Park Surgery and Watercress
Medical’s Mansfield Park Surgery in Medstead
are both on track to join The Wilson Practice
soon. Their enthusiasm is infectious! If your
surgery has the iSPACE bug, please contact us to
support you through the process.
Dementia Friendly surgeries: Wessex roundup

4. Poundbury Doctors Surgery,
Dorchester, became Dementia
Friendly in December 2015
Jane Goodson, practice manager at
Poundbury Doctors Surgery, said, “Eight
months later, I’d just like to say how
useful the staff felt that their dementia
training was. They have certainly put it to
use with regard to helping patients on a
day to day basis and looking out for ‘signs’
without drawing attention to the
situation. Staff are also about to receive
training in telephone scamming
awareness where the elderly/vulnerable
are being targeted.”
Penny’s Hill Practice in Ferndown,
Dorset, celebrated their accreditation as
a dementia friendly surgery in August
2016 with morning tea and cakes with
patients and carers, together with
representatives from Ferndown's
dementia friendly community.
The surgery has been very committed to
achieving the recognised status, working
with Dorset’s iSPACE team, Joanna
Bazalgette and Sue Sparkes.
They are supported by a very involved
Patient Participation Group who also
came along to enjoy the tea and cakes
and admire the symbolic forget-me-knots,
handmade by Dr Emma Richards, one of
the GPs very much involved with the
accreditation.
Hill Lane Surgery, Southampton
Practice manager, Paula Smith, says of
iSPACE, “It has revolutionised the annual
review. We used to just do blood
pressure, weight and it felt like a tick box
exercise. Now we have This Is Me’, we
take details of the carer and give
information about local services. Doing
iSPACE has tightened up our system and
improved our care.”
The doctors at Hill Lane are ready to use
This is Me if a patient with dementia has a
consultation – this photo was not staged!

5. Dementia Friendly stories: Canford Heath Practice
by James Leyland, Practice Manager
We had been hoping for some time to make
ourselves a Dementia Friendly surgery and so
when we heard about the ‘iSPACE’ tool we
were intrigued as to how we could
implement this in practice.
Becoming Dementia Friendly felt like a
daunting task before Joanna visited us, but
after she started talking us through what we
needed to do it all seemed so straightforward
and completely obvious! We wondered why
we hadn’t done it years ago.
Joanna kindly came along to our Protected Learning session and gave her dementia talk to
the whole staff, including the GPs. It was informative, funny, endearing, engaging and
simply marvellous! By the end of the talk everyone said how wonderful it was and it further
enhanced our determination to become Dementia Friendly.
We are currently in the process of looking at our signage, putting differently coloured loo
seats in place and having pictures of our GPs up on the wall to direct patients to where
their consulting rooms are.
We’re putting up a dementia notice board and from the information Joanna provided we
will soon have a new central point for everyone to look towards for dementia information.
After Joanna’s talk one of the receptionists was inspired to become our dementia
champion and we are in the process of supporting him through the process. It will be his
responsibility to ensure that everything we do is Dementia Friendly.
We are taking small steps, but thanks to Joanna and the iSPACE tool we feel far more
empowered to help our dementia patients get the very best from our practice.”

6. Before and after
Signage on the toilet doors at The Quarter Jack Surgery, Wimborne
Smart refurbished toilets at West Moors Group Practice

7. A Carer’s Perspective:
VVeronicainNorthDorset
Q. How long have you been
registered with your GP?
A. I have been registered for 38yrs
and Christopher 23yrs. I was widowed
before I married Christopher.
Q. How long is it since diagnosis?
A. 8 years.
Q. Can you tell us about your
experience of Christopher’s diagnosis?
A. Christopher was having funny turns
and we spent two years previous to
diagnosis going to specialists, we had
private insurance then. Finally he was
sent to Southampton Hospital for three
days and was finally diagnosed after many
scans and checks by Mr McMonagle. He is
now under Dr Kipps. They have always
been wonderful and we look forward to
our annual visit. Christopher narrowly
missed being included in a research
programme that he would have been on
for a year but the criteria were too tight.
Q. What was your GP’s response to the
diagnosis?
A. We went to our then GP a few months
after diagnosis about another matter. He
said nothing at all relating to the diagnosis
of a terminal, degenerating, incurable
disease that Christopher has. Christopher
was very upset at the time. I checked a
few years later that his diagnosis was on
the screen and the GP was prescribing
Aricept. No advice or information was
given.
Q. Do you feel you were dealt with
sympathetically?
A. Yes, at the hospital we were, but not
at the GP practice.
Q. What would have improved the way
you were given your diagnosis?
A. We should have had a meeting with
our GP or a memory advisor to be given
info and help. This was 8 years ago; I’m
sure things have changed.
Q. Were you given any information
about local services?
A. We were given no info about anything
until I rang the Alzheimer’s Society who
told me about the memory café in
Shaftesbury. There I met the Mental
Health Team that helped to run it with
the Alzheimer’s Society. So we then came
under them and they came every few
months to monitor the pills. When this
was all changed we fell between stools
and only discovered a memory advisor
recently having asked the Alzheimer’s
Society why there weren’t any!
When in dire straits I ring Liz who works
for the CMHT. And of course Elizabeth
Bartlett’s group (The Laverstock Memory
Support Group) is a fount of information
and support, but we waited two years for
there to be room for us, having seen
Elizabeth speak at a conference.

8. Q. How easy is it to see the same
GP/nurse for each appointment?
A. You ask to see a doctor that you
choose or who you can get an
appointment with. We found recently
that our registration had been moved to a
doctor we had never met and when we
went to see her, which she had
requested, she looked at her watch and
had not read her screen at all and forgot
to take Christopher’s blood pressure. She
had no idea of our circumstances.
Q. Do you feel that there is adequate
communication between health care
providers?
A. That’s difficult to answer as we see
so few. Southampton always sends a
report to our surgery. I have now checked
that I have Carer on my screen which I
didn’t have previously. When I said to a
doctor I was in a bit of a hurry as I was a
carer she asked if I was looking after my
grandchildren!
Q. Has there ever been a specific
situation which you feel could have been
handled better?
A. After we came under the mental
health team we were sent to a
psychologist. As we walked in, he said to
Christopher, “And what is wrong with
you?” We wrote a letter of complaint and
never saw him again.
Q. Do you feel that the community you
live in could be considered Dementia
Friendly?
A. No, I don’t think so, although anybody
we know - like the bank staff,
optometrist, garage, chemist, postman -
those that know are extremely helpful.
Q. Has your own GP practice been
accredited by iSPACE as a Dementia
Friendly Surgery?
A. No. I’m sure some of their difficulties
are that they have just become a lot
bigger joining with another surgery. Also
a lot of the doctors are part time. There is
also no Dementia doctor, which
considering the extent of the disease is
surprising.
A friend who attends Elizabeth’s group,
who is with the same practice, has the
same problems as us.”
Veronica adds, “When my first husband
had cancer we had our own doctor and
clinicians, who were friends, and they
popped in here to see us.
I know it was a long time ago. But that is
why we are on the Appeal Board for the
Alzheimer’s Society as we need to raise a
lot of money for care and research, and
importantly for post diagnostic support.”
Our sincere thanks to Veronica and
Christopher for sharing their experiences
with us.

9. Wessex clinical update
iSPACE – 27 surgeries have completed the
process to become Dementia Friendly
and 101 are in progress. The project will
continue for a further two years and aims
to reach 75% of all surgeries in Wessex –
there are 312 in total. Data about
diagnosis rates, care plans and
identification of carers is being collected
and people with dementia and their
carers are doing walkabouts in surgeries.
http://wessexahsn.org.uk/programmes/3
/dementia
Acute care development programme –
this has resulted in seven hospitals
adopting John’s Campaign. Three
dementia champion conferences were
held in Winchester, Bournemouth and
Salisbury and frontline staff benefited
from these events. Action cards were
completed and these are being reviewed
to assess impact.
Bournemouth University has conducted
an evaluation of the programme. You can
read the report on the Wessex AHSN
website at
http://wessexahsn.org.uk/programmes/3
/dementia.
Watch our film about John’s Campaign
http://wessexahsn.org.uk/videos/show?t
ag=Dementia
National news
In March 2016 the Implementation Plan
for the Prime Minister’s Challenge on
Dementia 2020 was published.
Complementing the NHS Five Year
Forward View, this plan sets out the
crucial enablers which need to be
implemented in the next two years in
order to meet the 2020 Dementia
Challenge.
Areas of focus include risk reduction,
health and care, post diagnosis support,
awareness and social action and
research.
The full implementation document can be
found on the Department of Health
website at this address:
www.gov.uk/government/publications/ch
allenge-on-dementia-2020-
implementation-plan
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