GPs should screen millions for dementia, MPs say

Millions of patients at risk of dementia could be screened for early signs of the disease to improve diagnosis rates, after an inquiry found stark variations in care.

A report by MPs and peers into the state of dementia services in the UK said GPs and other primary care workers should routinely check all people at risk of dementia to increase the numbers receiving a formal diagnosis.

The move would expand Prime Minister David Cameron's recent proposal to check all over-65s for symptoms.

MPs and peers want checks to be extended to all patients with learning disabilities, Parkinson's disease and Down's syndrome and anyone who has had a stroke. Added to checks for over-65s, this would mean millions more patients being asked questions to probe for signs of dementia each year.

The inquiry also found patients faced 'shocking' delays when seeking a diagnosis, with some forced to wait more than a year for an appointment at a memory service.

It recommended that GP commissioners invest in memory services, and said that the NHS should introduce targets to raise diagnosis rates. A national campaign may also be launched to improve awareness of symptoms.

'Shocking variation'
In March, an investigation by GP found memory services are being critically underfunded in parts of the UK.

60% of the 800,000 people with dementia are undiagnosed. One in three people over 65 will die with the disease.

The Unlocking Diagnosis report by the All-Party Parliamentary Group (APPG) on Dementia heard from people with dementia, carers, GPs and other health professionals.

It said diagnosis was key to providing a cost-effective dementia service, so much so that it is 'an imperative we cannot afford to ignore' in a time of economic austerity.

Yet patients are waiting too long for a diagnosis. Waiting times for memory services varied from just a few weeks to over a year. The average wait was three months.

Diagnosis rates also varied enormously: from 70% in Belfast to just 40% in parts of Wales.

The report said some carers and people with dementia saw their GP as 'barriers rather than gatekeepers' to a diagnosis. QOF is also impeding efforts to obtain a formal diagnosis, it said.

Although NICE does not recommend population-level screening, 'evidence received by the inquiry suggests there is room for an increase in regular checks for groups at particular risk of dementia', they said.

MPs and peers also called for a focus on dementia to be added to the proposed fourth year of GP training.

The inquiry found people frequently did not present their symptoms to their GP, with more than a third of carers reporting that patients had been waiting a year to visit their GP.

Memory services are significantly under-resourced in parts of the UK, with some patients waiting more than a year for an appointment. The report called on GP commissioners to secure better investment in these clinics, saying this could save the NHS £245m within 10 years.

'Patients being let down'
MPs and peers recommended introducing NHS targets to hold the NHS to account, including indicators in the Commissioning Outcomes Framework (COF), which will be used to judge clinical commissioning groups' performance from April 2013.

Local public health leaders should prioritise the improvement of diagnosis rates and create dementia-friendly communities, which was also outlined in the prime minister's vision.

Baroness Sally Greengross, chair of the APPG on Dementia, said: ‘We urgently need to make early diagnosis for people with dementia a priority and memory services are a key part of this. The prime minister has recently acknowledged the importance of improving quality of care for people with the condition, but there is still a lot of work to be done.

'Improving diagnosis rates will mean more people with dementia being able to access support and treatment that can help them and their family achieve the best possible quality of life.’

Jeremy Hughes, chief executive of Alzheimer’s Society, said patients were being 'let down' by services.

‘Through compulsory accreditation and investment in improving memory services we can help drive up rates of diagnosis and enable people with dementia to access the support they need,' he said.

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