GP postcode lottery fear on dementia care

Local services could struggle to meet the demands of the latest clinical guideline on dementia, GPs have said.

The NICE guideline, issued in conjunction with the Social Care Institute for Excellence (SCIE), states that all patients with mild to moderate dementia should attend cognitive stimulation programmes.  

But Dr Alan Middleton, a Devon GP with an interest in elderly care, said: ‘The main question is: how available is this?  

‘It is all very well saying that this is the therapy they want patients to have but if the service is not available then it is not acceptable.’  

He welcomed the decision to allow doctors to look at the whole clinical picture when deciding who is eligible for therapy with acetylcholinesterase (AchE) inhibitors.  

The guideline reiterates advice in the technology appraisal that AchE inhibitors to prevent cognitive decline should only be given to Alzheimer’s disease patients with a mini-mental state examination score of 10–20.  

But it also says patients with dementia with Lewy bodies or mild Alzheimer’s can be given the drugs if non-cognitive symptoms are causing significant distress.  

Some experts think this part of its guidance is muddying the water. But Dr Andrew Dearden, chairman of the GPC community care committee, said GPs should refer patients with mild cognitive impairment to memory assessment clinics under the guidelines.  

Dr Dearden added that memory assessment services may be able to deal with current levels of referrals, but they would struggle to cope with the increase in referrals suggested by these guidelines. 

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