Translation of evidence about dementia risk and its reduction into effective, equitable public health policy is a major challenge. To address this challenge, the National Institute for Health and Care Research Policy Research Unit in Dementia and Neurodegeneration at Queen Mary University of London (DeNPRU-QM) convened a multidisciplinary panel of 40 experts from across England, with diverse lived, academic, clinical, policy and advocacy experience, at various career stages, and of diverse gender and ethnicity, to develop actionable policy recommendations for dementia risk reduction. Through a 2-day in-person workshop and a subsequent three-round modified Delphi survey, the panel evaluated and refined statements on dementia prevention. The panel achieved consensus on 56 recommendations in four domains: public health messaging, individual-level interventions, population-level interventions and research commissioning. A key priority across all domains was the need to consider and address health inequalities so that prevention efforts do not exacerbate existing disparities. Our recommendations provide policymakers with a robust foundation for designing and implementing an evidence-based dementia prevention strategy in England and provide guidance that can inform approaches in other countries and contexts. By prioritizing clear communication, targeted intervention and sustained research investment, the recommendations can help to address structural inequities and advance dementia risk reduction. Ongoing cross-sector advocacy will be crucial in driving policy adoption and implementation. Translation of evidence about dementia risk into effective public health policy is a challenge. In this Consensus Statement, Demnitz-King and colleagues present 56 policy recommendations for dementia prevention, providing policymakers with a foundation for designing and implementing evidence-based dementia prevention strategies, prioritizing clear communication, targeted intervention and sustained research investment.

Background The mental healthcare workforce supporting people with dementia and comorbid mental disorders requires specific skills and knowledge. Aims We co-designed and conducted a survey to understand key issues facing community mental healthcare services accessed by older adults. Method We invited all English National Health Service (NHS) older people’s community mental health teams (OPCMHTs) in England to complete the survey. We compared service structures, resourcing and waiting times between regions, and considered how responses might inform current policy priorities. Results A total of 182 out of 242 (75.2%) English NHS OPCMHTs participated. We estimated there were 120 233 referrals to OPCMHT services per year, with 77.5% of services reporting increasing referral rates. In a quarter of services (n = 46, 25.3%), clients waited over a month from referral to initial assessment. Most services (107/181, 59.1%) experienced difficulties accessing in-patient beds for people with dementia, with rural regions more likely to report these difficulties. Half of the services (n = 100, 55.2%) reported providing higher-quality care for people with dementia than 5 years ago, despite increasing caseload complexity. Resource limitations challenged opportunities for prevention, care quality and collaborative working, and respondents rated team relationships with social services (n = 86, 47.8%), general hospital in-patient (n = 74, 41.4%) and out-patient (n = 54, 30.2%) services, and primary care (n = 54, 30.2%) as poor or requiring improvement. Conclusions OPCMHT service leads are committed to integrated working, but services are insufficiently resourced to realise their potential. Addressing challenges related to workforce retention, training and ways of working could optimise OPCMHT contributions to integrated care for people with dementia.

Background Dementia affects millions globally and presents diverse challenges shaped by personal, social and environmental factors. People living in under-served rural, coastal and deprived communities often face additional barriers to diagnosis, care and support, limiting person-centred approaches. These inequalities can negatively impact quality of life, social inclusion and health outcomes. Whilst dementia experiences have been widely studied, the influence of geographical context remains underexplored. Understanding this is essential to improving equitable, person-centred care across diverse settings.Methods MEDLINE, PsycInfo, Cochrane Library and Web of Science were searched from inception in February 2025 for qualitative studies on people's experiences of living with dementia in rural, coastal or deprived areas. The review was not limited by country or date. Data were coded and thematically synthesised using NVivo.Findings Seventy-three full texts were screened using Rayyan and 15 studies were included in the review. Thirteen studies were based in rural areas and two in deprived areas. No included studies were set in coastal areas. Four analytical themes were developed: navigating stigma, privacy and disclosure, navigating fragmented healthcare systems and services, lack of appropriate and accessible services and positive experiences of managing dementia.Discussion Key barriers to managing dementia included limited service availability, unsuitable support, stigma and logistical challenges. Findings underscored the need for person-centred, context-sensitive care that considers geographic, social and cultural factors. Future research should further explore diverse under-served settings to inform equitable dementia care particularly in deprived and coastal areas.

Objectives The study aimed to explore the acceptability of reducing the frequency of asymptomatic Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) screening among gay, bisexual, and other men who have sex with men (GBMSM)(Although the term GBMSM is used for convenience, the study also includes nonbinary people who were assigned male at birth who have sex with men.). Additionally, it sought to identify barriers and facilitators to implementing such changes and to develop potential interventions that could support a shift in current screening guidelines. Methods This qualitative study explored stakeholder perspectives on reducing screening frequency and identified potential interventions that could support future guideline changes of this kind. Semistructured interviews were conducted with 22 GBMSM and 8 professional stakeholders. Data were thematically analysed using the Capabilty, Opportunity, Motivation - Behaviour (COM-B) and Theoretical Domains Framework (TDF). TDF domains were mapped to behaviour change techniques to inform intervention development. Candidate interventions were refined based on acceptability, practicability, effectiveness, affordability, side effects, equity. Results Overall, GBMSM stakeholder responses to discontinuing asymptomatic Ng and Ct screening tended to be negative, while professional stakeholder opinions were mixed. Reducing the recommended screening frequency to 6 monthly was generally more acceptable to both groups. Barriers and facilitators to guideline changes included issues of knowledge and trust, social influence and identity, context and resources, concerns about consequences and emotional responses and habit. Ten candidate interventions were suggested. These involve providing information, social support, behavioural substitutions and feedback as well as facilitating discussions to resolve concerns. Conclusion Any reduction in the recommended frequency of asymptomatic screening will encounter a range of interrelated barriers, including knowledge gaps, social influences and emotional factors. We identified evidence-based interventions that could improve acceptance and minimise unintended consequences. Future research should incorporate stakeholder workshops to refine these strategies.

BACKGROUND:Digital multidomain interventions hold promise for dementia risk reduction; however, populations at higher dementia risk, including those experiencing socioeconomic and educational disadvantage, remain underrepresented in trials, and engagement with digital interventions often declines over time. Coproduction and blended models that combine digital tools with human support may improve reach, acceptability, usability, and sustained engagement. Designing interventions that are usable and acceptable for individuals facing structural, educational, or digital barriers (underserved groups) is therefore likely to produce solutions that are both accessible and scalable for the wider midlife and older adult population. OBJECTIVE:This study aims to describe the coproduction process used to develop ENHANCE (Tailored Intervention for Brain Health and Cognitive Enrichment)-a coach-supported digital intervention targeting 10 modifiable dementia risk factors in older adults from underserved groups-and report key outputs and lessons learned for equitable digital prevention design. METHODS:We coproduced ENHANCE between July 2023 and February 2025 using a multistage development process guided by the Medical Research Council framework for complex interventions and the Double Diamond design model. The person-based approach informed user-centered guiding principles (key design objectives), while behavior change content was operationalized using behavioral change theories. Coproduction followed 4 phases. The Discovery phase explored barriers to engagement with existing digital materials and identified candidate components for each dementia risk-factor module. The Define phase translated these insights into guiding principles and blueprints of each risk-factor module integrated with behavioral change components. The Design phase involved iterative co-production and usability testing of prototypes. The Delivery phase evaluated a high-fidelity prototype through a 1-week usability study with coaching support. Contributors included 162 research participants recruited from underserved community settings, 33 patient and public involvement contributors, and 4 human-computer interaction experts. Throughout development, coproduction focused on reducing literacy, digital confidence, and cultural barriers to maximize usability across diverse adult populations. RESULTS:Coproduction produced (1) evidence-informed module strategies for targeted dementia risk factors; (2) a set of guiding principles to ensure low-literacy, culturally relevant, and accessible content, supporting both equity of access and wider population usability; (3) a meadow-themed app integrating tailored check-ins, educational videos, cognitive training games, and in-app messaging; and (4) a structured coaching model, including onboarding, brief follow-up, and accompanying coaching manuals. Iterative testing and refinement improved navigation, simplified language, reduced text burden, and ensured the use of familiar and accessible game formats, resulting in a feasibility-ready prototype. CONCLUSIONS:ENHANCE is a coproduced, coach-supported digital intervention designed to be accessible for underserved midlife and older adults at increased dementia risk, with design features to support accessibility, engagement, and scalability across the wider aging population. The development process illustrates how integrating coproduction with behavioral science and usability methods can support principled intervention design for equitable digital dementia prevention.

INTRODUCTION:Refining programme theory following feasibility testing is a critical but rarely reported step in the development of complex interventions, creating a 'black box' in implementation science. This lack of transparency limits understanding of how and why interventions work and constrains effective scale-up and adaptation. This challenge is particularly salient in post-diagnostic dementia support, which is often fragmented in primary care, with limited guidance on how system-level interventions can be implemented and adapted in real-world settings. The PriDem programme developed a flexible, primary care-led intervention to improve post-diagnostic dementia support, involving Clinical Dementia Leads (CDLs) working with general practices to strengthen care systems. Programme theory was articulated in a logic model, to guide a feasibility implementation study, which demonstrated intervention feasibility, acceptability, and potential for systems-level change. Understanding how the intervention operated in practice was critical to refining this theory and informing future scale-up. This paper presents a structured exemplar of theory refinement, addressing this recognised gap in implementation science. METHODS:A deductive thematic analysis was conducted, using the logic model as a coding framework. We synthesised previously reported findings with new qualitative insights from feasibility interviews, fieldnotes, supervision records and researcher reflections. Confirmed, refined, and newly emergent theoretical components were identified and the logic model updated. RESULTS:Many original theory elements were confirmed, including improved review processes leading to enhanced care plan personalisation and staff training increasing confidence in care delivery. New mechanisms were identified, such as mapping local services as a relational tool and dementia review templates as educational resources. Pre-implementation activities, such as specific CDL training and champion identification, emerged as critical to success. Role ambiguity and capacity concerns acted as negative mechanisms, impeding implementation. These insights informed a revised logic model to guide future scale-up. CONCLUSIONS:This paper demonstrates the value of theory refinement following feasibility testing. By unpacking the 'black box' of implementation, we offer a transparent model for optimising complex interventions in primary care-led dementia support. TRIAL REGISTRATION NUMBER:ISRCTN11677384.

Background Dementia affects over 57 million people worldwide. UK and international policy position personalised, conversation-based care planning as central to post-diagnostic support. However, delivery in primary care is inconsistent, and many practitioners lack dementia-specific communication training. Existing evidence focuses on single roles or settings, leaving a gap in understanding how communication operates across the primary care workforce. Aims To identify what helps and hinders effective communication for integrated dementia care planning and determine the support and training needs of the wider primary care workforce. Methods Semi-structured interviews - 11 people with dementia, 13 family carers, and 19 primary care practitioners from diverse roles, exploring experiences of care planning conversations Reflexive thematic analysis Results Three themes were developed, progressing from micro-level communication practices (Theme 1: Beyond the tick-box), through triadic dynamics (Theme 2: Balancing voices in the conversation), to organisational influences (Theme 3: From silos to meaningful shared care planning). Time and Conversation as intervention cut across all themes, shaping trust and disclosure. Participants reported reliance on tick box approaches, inconsistent preparation, and uncertainty about care plan purpose and ownership. Non-clinical roles were commonly viewed as well placed to support meaningful conversations, but were often described as constrained by unclear remit and weak integration. Conclusions A persistent gap remains between policy ambitions and everyday practice. Time-pressured, checklist-driven encounters and fragmented systems undermine shared decision-making. The expanded primary care workforce offers untapped potential to address these gaps, but this requires clearer roles, formal integration, and targeted investment in communicative skills. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Alzheimers Society Grant 597 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Wales REC 4 (24/WA/0167 ) and Health Research Authority gave ethical approval for this work on 17 June 2024. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. Due to the sensitive nature of the qualitative data collected for this study, and the ethical restrictions associated with participant confidentiality, the datasets generated and analysed are not publicly available. De-identified interview transcripts may be made available to bona fide researchers for secondary analysis, subject to appropriate ethical approvals and assessment of suitability. Requests for access should be directed to the corresponding author at s.a.griffiths{at}ucl.ac.uk . Access will be considered by the authorship team in line with the original ethical approvals and data governance arrangements.

During the COVID-19 pandemic, remote primary care services were rolled out in England at unprecedented rates; this systematic change was met with public concerns, especially around healthcare quality and equity in access. To understand the policy rationales for using remote services and the standards for such services through an equity lens, we conducted a review of policies and guidelines. In policies and guidelines, remote services were portrayed as an opportunity to improve and restore services after the pandemic. Remote services should adhere to the same standards as face-to-face services, while local surgeries (clinics) and general practitioners (GPs) had flexibility to decide the best approach given circumstances. While there was acknowledgement of inequity in digital access, policies and guidelines overlooked complexities of delivering services to a heterogenous population. Future policies would benefit from clearer definitions and roles of different healthcare modalities and clearer evaluation plans to constantly improve primary care services.

Background: Over the past decade, remote (non-face-to-face) services — including interactions via the telephone and online platforms — have been increasingly used in primary care. These services bring potential benefits, as well as potential barriers, for patients. Older migrants are a population that could face intersectional barriers when accessing health care; it is important to understand the impact of remote services on them. Aim: This study explores older Chinese migrants’ experiences of, and attitudes to, remote access to primary care services. Design & setting: A qualitative semi-structured interview study. Method: Recruitment was carried out in 2023, through community organisations, social media, and snowballing. Participants were individuals aged ≥60 years, who self-identified ethnically as Chinese, and were UK residents; they were purposively sampled for maximum variation in sociodemographics and backgrounds. Data were collected through semi-structured interviews conducted in English and Mandarin. Interviews were recorded and transcribed verbatim; if consent to record the interview had not been given, field notes were taken. Transcripts and field notes were analysed using reflexive thematic analysis. Results were shared with participants for verification. Results: Nineteen participants were interviewed. Many technical and practical barriers were reported as existing for the participants when accessing primary care remotely. Due to the different levels of access to resources, these barriers affected the most disadvantaged people to the greatest degree. In addition, participants felt the need for in-person interactions to address some concerns and believed remote services should not replace in-person care. Conclusion: Overall, older Chinese migrants felt few benefits from using remote primary care services. In the current digital context of the NHS, it is crucial to keep multimodal services available while rolling out new service modes, and to consider the needs of different populations to ensure equitable access.

BACKGROUND:Chlamydia is the most diagnosed sexually transmitted infection among young people in England. Repeat infections are common, and the risk of complications from chlamydia increases with the number of lifetime infections. National guidelines recommend retesting 3 to 6 months after treatment; however, retesting rates remain low at 10% to 14%. The objectives of this study were to explore barriers to, and identify potential interventions to improve, chlamydia retesting among young people in England, using the behavior change wheel. METHODS:Qualitative semistructured interviews were conducted with 22 people aged 16 to 24 years who had previously been diagnosed with chlamydia. Participants were recruited from sexual health services in London, the South West, and the North West of England. An inductive thematic analysis was conducted, followed by thematic categorization to the behavior change wheel. RESULTS:Barriers to retesting included low awareness and knowledge of the recommendation, and differences in how the term "retest" was interpreted. Participants' experience of the initial test influenced their willingness or intention to retest. Possible interventions to overcome barriers include routine discussions of retesting at diagnosis and the rationale behind the recommendation, retesting reminders from service providers, and opt-in self-sampling kits. CONCLUSIONS:Lack of awareness and varied interpretations of retest present challenges to retesting. Interventions such as routine discussions, text reminders, opt-in self-sampling kits, and clear guidance could improve awareness and understanding, and streamline the process. Future strategies should be developed with stakeholders and patients and assessed for acceptability, practicability, effectiveness, affordability, side-effects, and equity to maximize their real-world implementation and public health impact.

OBJECTIVE:As populations age globally, there is increasing prevalence of multiple long-term conditions, such as dementia, leading to many challenges. The burden on health and care services, economic pressures, and the necessity for innovative policies to better support older people and people with dementia becomes paramount. This review explores how clinical pharmacists working in UK primary care support older people and people with dementia. DESIGN:Scoping review. METHOD:This review was conducted following the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. The search of Scopus, EMBASE, CINAHL, Web of Science, PsycINFO, and Cochrane was initially conducted in September 2022, and updated in August 2024. Searches included literature exploring the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences. RESULTS:A total of 30 articles were included. These detail the multifaceted responsibilities of clinical pharmacists in primary care for older people. Stakeholder perspectives, including healthcare professionals and patients, emphasised the positive outcomes of clinical pharmacist involvement, from reducing other practitioners' workloads to improving patient safety. However, communication gaps, concerns about competence from other healthcare professionals, and the need for clear role definitions emerged as challenges. Research focused on the experiences of underserved groups, such as people with dementia or from minority ethnic backgrounds, is lacking. CONCLUSIONS AND IMPLICATIONS:The review enhances our understanding of the primary care clinical pharmacist service in the UK and identifies gaps in evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. It provides insights into what makes an effective clinical pharmacist service, such as training and communication, which may help to inform international policy and practice and improve service provision globally.

BACKGROUND:The number of people living with dementia is increasing, placing significant strain on healthcare systems and family carers. Primary care teams, including clinical pharmacists, are crucial in supporting people with dementia. While clinical pharmacists have demonstrated benefits in other areas of healthcare, their role in dementia care is less understood. This study aims to explore the perspectives of people with dementia and family carers on the potential contributions of clinical pharmacists to dementia support within primary care in England. OBJECTIVES:To explore the views and perspectives of people with dementia and family carers of dementia care received from primary care teams, with a specific focus on clinical pharmacists in England. METHODS:We conducted thirteen semi-structured interviews with family carers and fifteen with people with dementia in 2022-2024. Interviews were analysed using reflexive thematic analysis. RESULTS:Three overarching themes, were developed from the interviews: 1) Recognising the value of clinical pharmacists 2) Building and developing rapport, with personalised care and a holistic approach; and 3) The needs of patients without clinical pharmacy support - left in uncertainty about their care. CONCLUSION:This study highlights the potential of clinical pharmacists in dementia care, highlighting both positive experiences as well as unmet needs of those who did not have access to the service. Awareness of these services hinder the impact that they might be able to achieve otherwise. Increasing awareness, standardising training, and further research on service delivery models are crucial.

BACKGROUND:While advance care planning (ACP) is linked with clinical and psychosocial benefits for older adults and their informal carers, uptake is low. Inadequate communication skills amongst clinicians has been identified as a key barrier to effective ACP. While existing literature reviews have focussed on hypothetical preferences, barriers and facilitators, none have examined direct experience of ACP communication with this population. The aim of this review was to identify and synthesise qualitative evidence regarding the communicative practices used to support older adults, informal carers and health and social care professionals (HSCPs) have ACP conversations. METHODS:A systematic review of qualitative evidence and narrative synthesis were undertaken. Five electronic databases (Medline, CINAHL, Emcare, Embase, PsychInfo) were systematically searched from inception to August 2024 for eligible studies reporting on features of ACP communication between HSCPs, older adults and informal carers. Quality appraisal was completed, with thematic analysis used to synthesise findings from eligible studies. FINDINGS:From 6348 titles identified, 264 full texts were assessed for eligibility. Twenty-eight articles reporting on 25 studies were included in the narrative synthesis. Four analytical themes were generated: (i) Introducing a delicate topic; (ii) Participation within the care triad; (iii) Professional influence in decision-making; (iv) Patient perspectives on planning and care. CONCLUSIONS:ACP conversations would benefit from improved, personalised information provision to support informed decision-making, with clear, compassionate communication facilitated by continuity of care. Future research should further examine the role of informal carers, nonverbal communication, and take a broader view of ACP as an interactional process.

Background Since 2010, NHS multiple sclerosis (MS) services have transformed to deliver disease modifying therapies (DMTs). To inform future service developments, including intended policy shifts towards care closer to home, we surveyed staff working with different service models across England about their experiences of care delivery. Methods We co-designed a survey with clinicians, academics and people with lived experience of MS, to capture structures and processes in four diverse service models; and explore what service innovations staff are most proud of, and what they perceive as the main current challenges. Results We surveyed 12 healthcare professionals, developing four case studies. Service A was the most well-resourced team (24.1 Full Time Equivalent (FTE) staff/ 2800 patient caseload) and the only service that had reviewed most clients within a year. The MS team travel to satellite units to see patients. In Service B (7.2 FTE/ 2100 patients), patients travel from district general hospitals (DGH) to the specialist centre. In Service C (5.3 FTE/ 950 patients), the MS team were located within the DGH and networked to a neuroscience centre. In Service D (5.4 FTE/ 305 patients – but with 700 further patients supported) there was bi-directional flow between a neuroscience centre and DGH; with most clients living outside the commissioned area and many in joint care arrangements. Across all services, respondents were proud to deliver guideline-based care; MS nurses provided a point of contact and were responsible for safety monitoring; all provided patient-initiated services and MDT discussions (with neuroradiology) around all switching/ escalating DMT decisions. Key challenges were identified around workforce (recruitment and retention), and rising caseloads; concerns around care inequities due to limited home treatment availability for DMTs; and limited support for functional neurology, vocational rehabilitation and specialist psychology, dietetics and community provision. Conclusion Respondents consistently highlighted gaps in provision of functional neurology services, specialist psychological therapies, dietetics and community support; and vocational rehabilitation services. To align with 10-year health plan, there is a need for workforce capacity and training development to support far greater access to MS care and treatment pathways close to home, including for those with multiple long-term conditions.

Background: Best healthcare practice for people with dementia encourages the inclusion of family members or carers, alongside enabling people with dementia to make their own decisions. Dementia care thus often includes the person with dementia, their carer, and their healthcare professional (HCP): a dementia care triad. Understanding how this triad is developed and navigated may improve future dementia care services. Methods: A longitudinal qualitative approach was used to interview 30 people with dementia, 31 family carers, and 7 healthcare professionals in England between May 2020 and March 2021. Data from three interview time points were transcribed and analysed using reflexive thematic analysis. Findings: The relationships within a dementia care triad were initially built on the dyadic relationship between the person with dementia and their family carer and any pre-existing relationships with their HCP. The nature and proximity of the carer to the person with dementia influenced how triadic relationships in dementia care formed and functioned, with spousal and co-resident carers more actively involved in healthcare interactions. Further positive development of a triad required confidence in the HCP, and shared perspectives on balancing the involvement of the carer and the independence of the person with dementia, with considerations of autonomy and risk, and which did not always follow a linear transition. While increased carer involvement often supported the person with dementia, it sometimes led to their exclusion. Engagement by healthcare professionals varied, reflecting inconsistencies in applying person-centred care. Conclusions: The findings of this study suggest a need for clearer, more consistent approaches that support dynamic carer roles while preserving the autonomy of the person with dementia. This study provides additional considerations in relationship dynamics that inform our understanding of the dementia care triad.

BACKGROUND:There are 900,000 people with dementia in England and Wales. Existing models of post-diagnostic support are unsustainable and unaffordable. The PriDem programme developed a new model of primary care-based dementia care, whereby a Clinical Dementia Lead (CDL) would facilitate systems-level change. AIM:To assess barriers and facilitators to implementation of the PriDem intervention. METHODS:7 general practices participated in a qualitative process evaluation, as part of the mixed-methods feasibility and implementation study. Practices were located within 4 Primary Care Networks in the North East and South East of England. 26 healthcare professionals, 14 people with dementia and 16 carers linked to participating general practices participated in semi-structured individual and small group interviews. Additional qualitative data were generated through nonparticipant observations and researcher fieldnotes from CDL intervention supervision sessions. Data were analysed using abductive codebook thematic analysis informed by Normalisation Process Theory (NPT). RESULTS:Six themes were generated: 1) The rocky ground of primary care; 2) The power of people; 3) Tension between adaptability and fidelity; 4) Challenging the status quo: reimagining care planning; 5) One size doesn't fit all; 6) Positive effects on people and systems: towards sustainability. Through the lens of NPT we can understand the contextual challenges facing primary care, the mechanisms (e.g., work undertaken by individuals) to overcome those challenges, as well as the potential outcomes of such an approach, in terms of longer-term sustainability of changes made. CONCLUSIONS:Despite the pressures facing primary care within England and Wales, meaningful change can be made to practice in the care of people with dementia. The presence of motivated and engaged staff are critical to implementation, as is ensuring understanding of complex interventions, so that fidelity can be maintained. People with dementia and carers benefitted from improved care systems. Commissioners should consider the benefits of a CDL-led approach.

Objectives Trans and/or gender diverse (T/GD) people in the UK are less likely to access sexual health services (SHS) than cisgender people and are more likely to report negative experiences. The British Association for Sexual Health and HIV (BASHH) developed expert recommendations for T/GD-inclusive SHS, but these lack service user perspectives. This study addressed this gap by asking T/GD people how SHS could be T/GD-inclusive.Methods Semistructured interviews (n=33) and focus groups (n=26) were conducted with T/GD people aged 17-71 years old recruited through community organisations and social media, exploring experiences of SHS and inclusivity. Study design, materials and analysis were informed by T/GD people and an advisory committee of charities and sexual health clinicians. Data were analysed using thematic analysis, managed using NVivo.Results Participants often expected that SHS were not set up for T/GD people. This was reinforced by poor experiences in other healthcare settings and the lack of information on NHS websites. Some participants had been denied care because they were 'too complex'. Participants wanted to know that SHS had engaged with the needs of T/GD people and looked for hallmarks of inclusivity, such as Trans Pride flags in reception areas. Some participants wanted specialist T/GD services, but others preferred to access general SHS. Staff attitudes were a key factor underpinning inclusivity. Anticipating having their identity questioned or needs dismissed, participants sought kindness and openness. Although the needs of T/GD people are diverse and different from cisgender service users, participants stressed that SHS staff already had the skills to deliver sensitive person-centred care and emphasised the value of inclusive SHS.Conclusion These findings provide insight into what a sample of T/GD people in the UK consider important for T/GD-inclusive SHS. Participants' suggestions align with and reinforce BASHH expert recommendations. Importantly, they highlight the need for ongoing engagement to deliver T/GD-inclusive SHS.

INTRODUCTION:People with dementia experience complex healthcare needs. Clinical pharmacists play a crucial role in optimising medication management and ensuring patient safety within the primary care setting. However, little is known about the specific barriers and challenges they face when delivering dementia care. This study investigates the safety of dementia care in the community, focusing on the experiences of clinical pharmacists. METHODS:A qualitative study using semi-structured interviews with clinical pharmacists. Data analysis employed codebook thematic analysis, guided by the SEIPS 2.0 framework. RESULTS:Thirteen clinical pharmacists were interviewed. Key risks include variations in pharmacist expertise, communication barriers, limited resources, and systemic challenges. Using the SEIPS 2.0 framework, the complex interactions between work systems (people, tools, tasks, organisation and environment) and work processes were identified, which impact safety outcomes for both clinical pharmacists and people with dementia. CONCLUSIONS:Interviews revealed a spectrum of risks associated with dementia care in primary care. This study highlights the complex interplay of factors influencing the safety of dementia care. A proactive, multifaceted approach addressing training, interprofessional collaboration, and system-level adaptations is crucial to mitigate these risks and enhance patient safety in dementia care.

Introduction Evidence suggests that social prescribing might have a positive impact on identity, control, creativity and quality of life in people with dementia. While evidence on the benefits of social prescribing is accumulating, there is a sparsity of research on the experiences of social prescribers. This study aims to identify the challenges that social prescribers face when supporting people with dementia and their families and strategies to address these. Materials and methods A qualitative study involving 24 social prescribers from all regions in England. Semi-structured interviews investigated challenges and strategies that social prescribers experience in their own practice. Data were analysed through thematic analysis. Results on “Challenges” and the respective “Strategies” are presented in a chronological order that reflects the different stages of contact with and support for the client with dementia, from referral to discharge. Results and discussion This study identified unique barriers that social prescribers face when working with people with dementia, particularly around communication, motivation, engagement and overdependency. It identified person and system-level strategies that can be used to address these challenges. These include expanding opportunities for dementia training, offering in-person support, including social prescribing in annual dementia reviews, and increasing integration of services within Integrated Care Systems and collaborations between health care service providers and with the third sector. Improving delivery and effectiveness of services is crucial to ensure that social prescribing fulfils its ethos of personalised care approach for all, including people with dementia, as envisioned in the NHS long term plan.

AIMS:The prevalence of multiple long-term health conditions including dementia is rising globally. Managing dementia presents significant challenges for healthcare providers. Clinical pharmacists, with expertise in medication management, have emerged as valuable members of the primary care team. However, there is a need for further research to understand their specific role and experiences in supporting people with dementia. The aim of this paper was to explore the views and experiences of primary care based clinical pharmacists in supporting people with dementia in the community. METHODS:We conducted 13 semistructured interviews with primary care clinical pharmacists in England in 2023-2024. Data were analysed using reflexive thematic analysis. RESULTS:Three overarching themes were developed from the data: (i) holistic care beyond medication management; (ii) the integral role and capacity of clinical pharmacists in the healthcare team and system when delivering dementia care; and (iii) building expertise in dementia care and defining the role of a clinical pharmacist. CONCLUSION:Clinical pharmacist roles have the potential to extend beyond medication management to deliver holistic support, as part of primary care based multidisciplinary teams and take a proactive approach to care for people with dementia. Findings highlight the importance of confidence, training and a supportive workplace environment for clinical pharmacists to effectively contribute to dementia care.