Dementia tsar calls for GP-led diagnosis

Patients with suspected dementia should be formally diagnosed by GPs in general practice as well as by memory services, England's dementia tsar has said.

GPSIs should lead on dementia diagnosis, according to England's dementia tsar (Photo: Paul Starr)

Professor Alistair Burns, national clinical director for dementia at NHS England, said he wanted to see GPSIs diagnose the degenerative disease so that it can be managed by practices in the same way as other long-term conditions.

GPs are currently encouraged to refer suspected cases to memory services for a formal diagnosis, but these have been hit by long waiting lists in recent years.

Professor Burns also dismissed claims that the dementia case-finding DES introduced in April 2013 amounted to population screening, after GPs had criticised the scheme.

Estimates suggest just 46% of people with dementia have received a formal diagnosis. NHS England wants to increase this rate to two-thirds, with post-diagnostic support for all patients.

A GP investigation in July found that elderly patients waited up to a year for a formal dementia diagnosis due to huge delays at stretched memory services. GPs warned the DES could increase strain on services.

At a Westminster Health Forum event on dementia in London on Tuesday, Professor Burns said he wanted general practice to take a greater role in dementia care to achieve the two-thirds target.

He said: ‘One of the things I’d like to do is think of dementia a little bit differently. Some of the discussions I've heard... [are] almost to recast dementia as a long-term condition, diagnosed and managed in primary care.

‘For sure we need memory clinics, for sure we need some memory services; but wouldn’t it be great to see that diagnosis, whether it’s [by] a GPSI, or a GP with an extended role, something that is in primary care.'

GPs have warned that the ‘target-driven’ focus on diagnosing huge numbers of patients with dementia risks sidelining resources for post-diagnostic support services.

Some argue that the current dementia case-finding DES amounts to screening, which is not supported by the UK National Screening Committee.

But Professor Burns rejected this notion, saying the DES encouraged targeted assessment in high-risk patients and that screening would not be ‘appropriate’. 

However, he admitted that ‘perhaps we don’t get these things right 100% first time’, and said that the DES, which will continue next year, will be reformed to ‘put clinicians in the driving seat’.

GP scepticism 'extraordinary'

But Jeremy Hughes, chief executive of the Alzheimer’s Society, who also spoke at the event, attacked GPs’ scepticism over the DES.

He said it was ‘extraordinary’ that some GPs were ‘decrying’ the fact they are being asked to bring up the subject of dementia with their patients. ‘To think, you can actually have patients who are elderly, vulnerable and frail, who are coming to the GP for another reason and the GP might choose not to ask them about their dementia.’

Dr Chris Streather, managing director of Health Innovation Network South London, told the conference the argument that some patients may not want to be asked about signs of dementia could be used 'to justify doing nothing'.

He said: 'If we don’t give an equitable level of investment into dementia then it’s a self-fulfilling prophesy: there’s no point making a diagnosis because there’s nothing we can do. But actually the two things have got to go hand in hand.'

Speaking at the event, Sally Warren, director of programmes at Public Health England, said: ‘There’s no point of having a timely diagnosis just for the sake of having a timely diagnosis. What you need to have is that timely diagnosis opens to door to an appropriate set of responses, be that from health services, social care services, or actually helping you navigate what [are] quite often huge resources in the voluntary community at the local level.’

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