Diagnosis and Post-Diagnostic Support in Primary Care

The Post-diagnostic Support (PDS) in Primary Care programme was commissioned by Scottish Government to test the relocation, or closer alignment, of dementia diagnosis and PDS into primary care.

In March 2018 Focus on Dementia began working with three GP clusters – Shetland, East Edinburgh and Nithsdale in Dumfries and Galloway. Each selected site was supported to innovate in order to allow for a greater range of learning from aspects of delivery that best suited local contexts. This resulted in the following changes:

  • Nithsdale testing nurse and occupational therapist-led dementia diagnosis and locating this in clinic in GP surgeries
  • East Edinburgh delivering pre- and post-diagnostic support and PDS group-work from their surgeries, and
  • Shetland’s nurse-led diagnosis assessment service being completed by a discrete PDS practitioner.

You can watch the animation below which summarises the key activities.

Blake Stevenson Ltd, an independent social research company, externally evaluated the work to fully capture and report on the impact of relocating dementia expertise into primary care. 

Healthcare Improvement Scotland also produced a report outlining the key findings and our role in the programme. 

Virtual groupwork case study 

East Edinburgh PDS in Primary Care site introduced virtual groupwork sessions for people with dementia and their carers when, due to the COVID-19 pandemic, the team could no longer host face-to-face sessions. They produced a case study to share their experience.

Videos from staff involved  

To hear the experiences of staff members from across this programme of work, you can list to our "in conversation with" videos which give you the perspective of those involved in testing diagnosis and PDS in a primary care setting.  

A guide to making general practice dementia friendly

People with dementia can experience difficulties in attending general practice, which can create barriers when even the best care and support is in place. They may experience difficulties with:

  • not remembering to attend appointments
  • navigating the physical environment of the practice
  • not being able to express their concerns in the short time available with the GP and
  • not recalling details of discussions regarding their care.

Experiencing difficulties when accessing GPs can impact on the quality of life and the health of people with dementia and their carers. It can also impact on the usage of primary care, emergency admissions to hospitals and transitions to residential care. 

We have created a guide, alongside Alzheimer Scotland, to making general practice dementia friendly. It is a self-assessment tool and includes a checklist for GP practices to help people with dementia and their carers access high quality care and support. It was adapted for Scotland from the Alzheimer Society’s guide of the same name with their kind permission. 

Case study

Benbecula Medical Practice were interested in using the guide and checklist to facilitate a structured approach to improving the way they work to support the patients in their practice who live with dementia. In this case study, Benbecula Medical Practice share their experience of using the guide.

To ensure everyone can benefit regardless of their characteristics or where they access care, we completed an equality impact assessment. This highlights key equality issues that were considered by our project team, and any actions we took in relation to them. We are keeping this EQIA under review as the project progresses and we may update it if we receive new information.

To find out more contact the team at his.focusondementia@nhs.scot​