The primary care annual dementia review: a qualitative study of the views and experiences of service users and providers

Abstract

BackgroundIn England and Wales, the Quality and Outcomes Framework (QOF) financially rewards GP practices for long-term conditions management, including completion of annual dementia reviews. There is limited evidence about how this works in practice and whether it meets patients’ and carers’ needs.MethodsData from five qualitative datasets were integrated and analysed thematically. Data comprised interviews, focus groups, and observations with 209 participants, including commissioners, managers and frontline staff in dementia services; people with dementia; carers; and policy experts.FindingsFour main themes were developed: (i) perceived benefits of annual review; (ii) variability and (in)visibility of annual review; (iii) logistics; and (iv) external influences and constraints.Variability in both the completion and quality of QOF annual dementia reviews was attributed by some to limited nuance in the current QOF dementia indicator. Many patients and carers were unaware that an annual dementia review had occurred. Participants suggested that many GPs lack the required competencies and/or capacity for successful dementia reviews.ConclusionsWork is urgently needed to improve the quality of annual dementia reviews. Potential strategies include changing the financial reimbursement to reflect both quality and quantity, so the review is tailored to the needs of the individual and their family; the creation of standardised templates; collaborative working within primary care and across sectors; and integrating dementia reviews into other long-term conditions.Key pointsQOF annual dementia reviews are a key opportunity for providing support for people with dementia in England and WalesCurrent provision of annual reviews varies both in completion rates and qualityStrategies for improvement include improving quality indicators, implementing standardised templates, and improving primary care capacity and capability to carry out reviews

Access to personalised dementia care planning in primary care: a mixed methods evaluation of the PriDem intervention

“…Many participants considered the 10-minute consultation model a key barrier to implementation of care planning, despite QOF recommendations that up to 30 minutes be allocated for this task. 20 In common with previous research, 29 we found that participating patients and carers were unaware of their entitlement to care planning but valued the opportunity to engage in a proactive and holistic discussion about their care when this was offered. Our findings align with recent suggestions that the QOF dementia review system is not meeting the needs of people with dementia and carers, and that financial reimbursement should be based on quality rather than purely quantity indicators.…”

“…Our findings align with recent suggestions that the QOF dementia review system is not meeting the needs of people with dementia and carers, and that financial reimbursement should be based on quality rather than purely quantity indicators. 29 NHS England has published guidelines for the provision of personalised care planning 14 ; however, the audit results suggest that even with a successfully implemented intervention these criteria may not be met. Post intervention, some items were only recorded in the minority of cases—for example, people with dementia and carers being provided with information on care planning in advance of the consultation or being given a copy of their care plan.…”

“…Not all care domains will be relevant to all patients and carers. 29 Commissioners of dementia services should consider the benefits of a CDL-led approach, which can result in people with dementia and carers benefiting from increasingly holistic, patient-centred care. This paper has reported on PriDem process evaluation findings specific to personalised care planning.…”

The memory clinic and psychosocial intervention: Translating past promise into current practices

“…Primary care could manage the task of post-diagnostic dementia care with additional financial resources for quality, over and above the “quantity-measured” reimbursements that are currently available ( 64 ). This may work where particular GP surgeries have strong leaders and dementia-specific nurses ( 26 ).…”

“…The situation does not appear to have changed. The PriDem study across England and Wales notes that despite some financial incentives, GPs may not have the capacity to deliver good quality dementia care ( 23 ). European primary care studies also report problems in GP engagement in delivery of dementia initiatives ( 24 , 25 ).…”