21 September 2021

The Brent Memory Service (BMS) provides assessment for and diagnosis of dementia. The comprehensive assessment of an individual’s memory means that, if dementia is an issue, a diagnosis is given as soon as possible. BMS also offers support to people with memory problems and their families.

The service temporarily closed in March 2020 due to Covid-19 which resulted in a long waiting list of referrals. When the service reopened four months later, the team found fresh and creative ways to recover and provide care for a long list of patients.

Bringing on new staff

Dr Chris Soosay joined the service as locum Consultant Psychiatrist in August 2020. The team employed new staff comprised of: a Consultant Psychiatrist, a Speciality Doctor, a Clinical Lead, five Primary Care Dementia Nurses, an Occupational Therapist, a full-time Psychologist, an Assistant Psychologist and an Administrator.

A new rota system

Gloria Achiekwelu, previous Clinical Team Lead, says: “we looked at the processes that we’d had before and ways in which we could improve them, leading to faster and more efficient diagnoses.”

Clinicians are now allocated four initial assessments (IAs) weekly, mostly in the office or at a patient’s home when required. When fully staffed, six nurses each complete four IAs every week – that’s 96 every month. This system successfully reduces the number of cases discussed during Multi-disciplinary Team Meetings (MDTs), leaving more time for complex cases.

Complex cases are seen as educational learning experiences for the team as they demand assessment and intervention from a multidisciplinary perspective. These cases include but aren’t limited to:

  • Early onset dementia especially in people under the age of 64
  • People who’ve recently suffered a stroke
  • Patients with symptoms of Parkinson’s Disease
  • Young patients presenting with underlying neurological causes
  • Patients with Bipolar diagnosis and dementia requesting medication change or review

There’s also an Assessment Psychologist in place to support clinicians and complete assessment tools like Addenbrooke’s Cognitive Examination III. This reduces the time taken to complete assessments.

Considering the order of treatment

Gloria Achiekwelu focused particularly on the duty referral triage. She says: “we have a robust system in place – as Clinical Lead, I was in charge of triaging referrals and offering advice to healthcare professionals. If initial assessments are cancelled, clinicians will request two referrals from our admin colleague to triage for one cancellation and four referrals to triage for two cancellations etc. Our admin staff are extremely efficient with this!”

Working with other teams

BMS works regularly with other teams, sharing good practice and accepting expert assistance. If patients have problems sleeping, the service refers them to the Dream Research Institute. They also refer patients with dementia, or carers who are willing to participate in research studies, to Join Dementia Research and the PATHFINDER Research Trial – this was developed to find out if Problem Adaptation Therapy (PATH) can be used to treat depression in people with dementia.

The service works with community teams including the Dementia Café, Dementia Hub and Ashford Place. If a patient is particularly isolated for example, the service might refer them to the community team or refer these teams to get in touch with them. They also refer patients who have social care needs to Brent Social Services for a Care Needs Assessment.

Performance Up!

The wait time from referral-to-assessment in Brent went down from 238 days in November 2020 to 95.9 in January 2021. This figure dropped to 68 in May 2021. The overall aim is to reduce the referral-to-assessment time which will improve the referral-to-diagnosis target. BMS aims to review the route and clear the waiting list to meet the National target of a 6-week referral-to-diagnosis period.

Team Support

Gloria says: “we were able to achieve all these things because of the amazing support we had in place. Urubia Eronini-Ukah (former Operations Manager) and Emma Barton (Older Adults Mental Health Service Manager) listened to staff compassionately and immediately established a sense of trust between everyone. We also appreciate the crucial support from Phillipa Galligan, Borough Director for Brent. Our team is very lucky to have leaders like this.”

Dr Abhishek Shastri recently joined the team as the new Consultant Psychiatrist for the Memory Service. He said: “everyone in the team has done an excellent job to bring an extremely long waiting list down to a stable level. It’s been a collaborative effort – staff have gone far beyond what’s expected of them and I couldn’t ask for anything more.”

What happens after diagnosis?

The Brent Memory Service is a diagnostic service. Prior to discharging patients, their clinicians provide psychoeducation and signpost them to different teams as follows:

  • When Cognitive Enhancers are prescribed – e.g. Memantine or Donepezil – clinicians discuss medication with the patient, families and carers. They provide and explain information leaflets about side effects that may occur and then monitor the patient for 28 days.
  • They liaise with patients and families during that monitoring period to make sure all is alright and then follow up with any concerns.
  • If the patient is stable on medication, with no side effects or concerns, they are discharged to the care of the GP in Primary Care.
  • The team provide useful leaflets that cover ‘living with dementia’, effective lifestyle changes, details on day centres and dementia hubs etc.
  • They signpost to different services so that patients, families and carers can get support with assessment of benefits, wellbeing services, socialising opportunities, peer support and research involvement. 
  • The team offered Cognitive Stimulation Therapy prior to Covid-19 but this had to stop during lockdown. They intend to start the group again as a professional to lead the group is employed. 

Note: Gloria Achiekwelu is no longer Clinical Lead for the Brent Memory Service. Gloria has moved to a new post as Team Manager of the Brent Older Adults Home Treatment Team. The new Clinical Lead, Pauline Ujeyah, started her post in September 2021.