A task-shifted approach to post-diagnostic dementia support: a qualitative study exploring professional views and experiences

Objectives: to explore the views of commissioners, service development leads, service managers and senior staff in selected dementia services on increasing the role of primary care in post-diagnostic support for people with dementia. Design: qualitative semi-structured telephone interviews and a focus group. Setting: participants were drawn from NHS Clinical Commissioning Groups, social care commissioning, and a range of dementia services across primary care, secondary mental health care, social care and the third sector. All participants were based in England or Wales. Participants: 61 professionals, comprising 25 commissioners or service development leads; 25 service managers; and 11 team leads or senior staff. Results: participants had varied views on whether a primary care-based approach for post diagnostic support for people with dementia and their families was appropriate, achievable and/or desirable. Potential benefits of a task-shifted approach were continuity and a more holistic approach to care; familiarity for both patients and staff; and reduction of stigma. Key challenges included the capacity, ability and inclination of primary care to deliver post16 diagnostic support for people with dementia and their families. We discovered a number of conceptual challenges to implementing a task-shifted and task-shared approach, including uncertainties around the nature of post-diagnostic support, the definition of primary care, and identification of tasks that could be shifted to primary care. Conclusions: our data highlight the concerns of key professional staff around greater involvement of primary care in post-diagnostic support for dementia. Further research is needed to achieve a shared understanding and consensus over what post-diagnostic support means in the context of dementia. We will be undertaking such research in the next phase of our programme.