Application Guidance

Dementia Friendly GP Practice Funding

  1. Applicant Organisation: name,address and contact details
Please provide the following:
  • Name(of clinical lead responsible for this project)
  • Practice Name
  • Practice Address
  • Tel No. (of clinical lead responsible for this project)
  • Email address

  1. Why you are interested in becoming a Dementia Friendly Surgery?
(word count limit: 400)
  • Demonstrate existing activity to create a dementia friendly environment.
  • Demonstrate awareness of the National Dementia Agenda and SCN outcomes.
  • Demonstrate a commitment to training, and improving DDR
  • Articulate Quality outcomes for patients and carers.
  • Longer term sustainability and plans for further roll out or sharing best practice
  • Evidence the viability of the project, including a commitment to it being completed by the end of March 2018 and evidence of a successful record in delivering outcomes.

  1. Dementia Friendly Action Plan
( Insert Template)
  • Applications should provide details of how the benefits will be monitored in SMART terms i.e. Specific, Measurable, Achievable, Relevant and Time bound terms to allow for monitoring and evaluation. This will also help show how core outcomes (listed below) have been achieved for the evidence and findings gathering exercise.
  • Evidence of robust examples from attached the resource toolkit, and/or applicants adding own ideas.
  • Applicants must commit to
i)Nominate a Dementia Clinical Lead
ii)Clinical Lead to participate in Thames Valley workshops over the year ( 2-4 events)
iii)Dementia Lead to become Tier 2 trained
iv)Action Plan to be published on the Dementia Action Alliance (DAA) webpage.
v)Quarterly reports on action plan progress to be made to the SCN and to their CCG.
vi)To contribute and share their learning with their respective CCG.
vii)80% of Practice Staff to be Tier one trained.
viii)To exceed the practice’s dementia prevalence rate to 67% (or forecast a realistic trajectory).
  1. Leadership Skills and what unique benefits can you bring? (word count limit: 400)
  • What leadership skills does the applicant the currently have?
  • Evidence of any other project (non-dementia related) that they've led and what were the outcomes?
  • What Dementia skills interest do they have?
  • How would their share their learning and skills?
  • What’s needed to develop their skills?
  • Who do they need to work with and influence? ( i.e. stakeholders etic)
  • How would the project become sustainable from 2018?
  • How would the applicant share learning and contribute to their CCG?

  1. Confirmation statement from your CCG that they support this application:

Signed (Practice Manager/lead Partner):
Date: