Dementia-friendly GP practices

Dyneley House surgery in Skipton has implemented various changes in an effort to identify itself as a community resource.

Hazel Foster’s biggest worry is getting lost, even in a place she’s very familiar with. A year ago the 73-year-old former mobile librarian, who travelled the Yorkshire dales delivering books, was diagnosed with dementia. “It’s important to me to have that safe feeling of recognising a place,” she says, before adding that she experiences this at her local GP practice.

In early 2015 the doctors at Dyneley House surgery in Skipton, North Yorkshire, invested in changes to their premises geared to creating a better space for patients with dementia. Not one of these is rocket science, nor high cost, and given that two-thirds of people with dementia live in the community, Dyneley House could be a signpost for dementia-friendly primary care in Britain.

It all started with a plan by the practice team to refurbish their tired building built in 1982. They saw an opportunity to make their reception area more dementia-friendly. At first they sought advice from the Alzheimer’s Society, then the Dementia Action Alliance and a King’s Fund guide to how a surgery like theirs could provide an environment which offers better support for people with dementia.

The team implemented aesthetic changes, such as fitting carpets with a solid colour and painting light, plain-coloured walls with contrasting skirting boards and door frames. They wanted to create a less confusing environment and enable people with dementia to feel more comfortable during their visits to the surgery.

“One of the issues for people with dementia is that if there’s a pattern in the carpet, they are not sure whether it‘s a barrier or a hole,” says practice manager Antony Radley.

He adds: “We have a carpet without any pattern, blocks or lines, and people with dementia feel more comfortable about walking around the building. We’ve got some quite bright blue paintwork around the skirting and the door casings, so people with dementia can identify where the opening is and feel more comfortable about walking through it.”

Radley worked with a local photographer to create pictures of familiar, local places and objects – the Dales, Malham Cove, dry stone walls, sheep – for the waiting room. The nearby Craven museum loaned some black and white photographs of Skipton in days gone by.

Martin Foster, Hazel’s husband, takes a positive view of the photographs: “Because [Hazel] used to be with the mobile library in the area, it brings back memories of a lot of the places that she’s been to while working.”

There’s a dementia-friendly clock with clear figures and the date, and improved signage, including an image to indicate the toilet, which has a colour-contrasting seat and light switch.

“The clock is a good one because a big problem for Hazel is knowing what time it is,” says Foster. “And even I can see the advantage of having a depiction of a toilet on the loo door because hunting out the toilets in a strange place can be difficult for anyone.”

Dyneley House’s dementia-friendly focus goes beyond building changes, however. “We’ve made a conscious effort, within perhaps the last six months, to identify the surgery as a community resource,” says Dr Bruce Woodhouse, one of 10 GPs at the practice, part of Airedale, Wharfedale and Craven clinical commissioning group.

“The idea of the surgery, as not just somewhere you come when you’re poorly, but somewhere you might come for a social but informative evening, has had very positive feedback. And it certainly has for dementia.”

Working with third sector organisations – Pioneer Projects, Making Space and Horton Housing included – the practice is delivering art classes, country walks, vegetable growing in the practice’s small garden, events for families and carers to understand more about dementia, and a café offering healthy living advice.

“We worked with an organisation called Carers’ Resource to do a session called memories and me, where people talked about their experiences throughout their lives,” says Radley. “And we had – this was fantastic – patients who were doing something called wash day blues. We had a dolly tub and people were doing washing in a very old-fashioned way.”

The practice employs a health promotion worker who flags these events with patients, but GPs highlight them too. “To begin with it feels a bit odd saying: ‘Would you like to join an art class’ in a consultation where you’re talking about referrals, pills or whatever, but it really is a positive step,” says Woodhouse.

What advice could he offer other practices about adopting a dementia-friendly approach? “I would say that it’s surprisingly simple. It’s a lot about common sense and it’s very much about joined-up working with the agencies around you.

“There are so many voluntary groups, charities, we just struggle to know who they are and what they do. But having made that little bit of extra effort to get connected to them, has been really positive. And those relationships will continue and hopefully they will come to us and say: ‘Can you do this?’ or bring ideas to us.

He adds: “And the other thing I would say is that patients with early dementia really appreciate this and feel they’re really being offered something which, for a condition that we can’t solve, is very positive.

“It’s simple, it’s actually quite fun, it doesn’t necessarily take a huge amount of effort and it’s a model for other conditions, I think.”

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