GP training key to DoH dementia plan

RCGP warns real failings being missed, says Tom Moberly.

GPs and new specialist memory services form the crux of the DoH's five-year dementia strategy for England, it was revealed last week.

Earlier diagnosis would improve care for dementia sufferers

Backed by £150 million of investment for its first two years, the initiative focuses on early diagnosis and treatment of the condition.

Launching the strategy, health minister Phil Hope stressed the key role of expanded GP training on dementia within the strategy.

'If we spot the signs and get earlier diagnosis, we can have earlier interventions and help sufferers and those who care for them have a better quality of life,' he said.

'This will mean people will be able to stay longer in their own homes, which is a particularly important part of keeping people with dementia well and also very important for their family and carers,' he added.

The changes are aimed at rectifying the huge geographical discrepancies in diagnosis and treatment of dementia. For instance, there is a 24-fold variation in diagnosis and treatment across PCTs and performance on diagnosis and treatment is at half the level of that in some equivalent EU countries.

Only one in three people with dementia are thought to ever receive a formal diagnosis.

Missing the real failings
However, RCGP chairman Professor Steve Field believes the focus on GP training misses the real failings of dementia care.

'Education and training can always be better, but it is access to services that is the problem,' he told GP. 'Secondary care, social care and primary care all need to be joined up.'

He said the RCGP welcomed the commitment to invest in memory services in secondary care and to develop clear referral pathways.

'There are a range of conditions that can look like dementia, such as depression, hypothyroidism and Parkinson's disease,' he said. 'But if these conditions can be identified early, they can be treated.'

However, Professor Field warned that new memory services would need to fit around existing services.

'We are not keen on the suggestion that there has to be a memory clinic in every town,' he said. 'What we don't want is to have a situation where a PCT has to put in a new memory clinic, regardless of the local situation.'

Focus investment
He said PCTs need to look strategically at where to focus investment. 'It may be that a memory clinic needs to be consolidated and that patients need to travel further to a clinic providing a wider range of services.'

More memory clinics will not, however, mean that GPs are removed from the care of people with dementia. Instead, these new secondary care services can be used by GPs in a clear and explicit care pathway.

The clinics will diagnose whether a patient has dementia and of what subtype, allowing GPs to modify treatment accordingly, the strategy says.

Mr Hope said that PCTs could choose to set up services led by GPs with a special interest in dementia.

'The commissioning process will need to ensure what is right for each particular area,' he said.

'It may be in some areas there are specialist GPs who understand and specialise in dementia, in other areas it may be a geriatrician.'

Dementia in numbers
  • £3.3 billion annual cost of dementia to the NHS. It costs the UK economy £17 billion a year.
  • 700,000 people in the UK have dementia, expected to rise to 1.5 million in the next 30 years.
  • One in three people with dementia receive a formal diagnosis.

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