The dementia ‘Golden Ticket’ – an emerging new model of care Buxted Medical Centre

Sussex has more people living with dementia than anywhere else in the country. A local clinical review identified issues with the current dementia care pathway, including that access to information and support for people with dementia is fragmented, that primary care is often ill-equipped to manage these patients, that post-diagnostic support is limited, and that there is no formalised approach to advanced care planning. These issues are resulting in poor outcomes for patients and high costs to the NHS.

This project led by Buxted Medical Centre seeks to address these local issues, as well as the recommendations in the National Dementia Strategy and the Prime Minister’s Challenge on Dementia 2020.

The project will involve developing a new approach to the management of dementia in primary care, including multi-agency post-diagnosis support. The ‘Golden Ticket’ is an innovative composite model of intervention delivered in primary care and the community. It seeks to address gaps in post-diagnosis support, and will look at where the management of slow-declining dementia could be more appropriately managed in primary rather than secondary care.

The model includes: interventions to ensure timely access to health and social care pathways; coordinated and supported access to personalised psycho-social interventions; primary care based clinics; the new role of the ‘Dementia Guide’; and personalised advanced care planning.

The Golden Ticket will be embodied in a document that will become a navigation tool for the dementia journey, supporting the patient, carer and multi-agencies in the actions needed to enable/realise or maintain a good quality of life.

Contact details

For more information, please contact Kim Grosvenor, Senior Manager at NHS High Weald Lewes Havens CCG.