Viewpoint: 'Dementia DES will worsen waiting times'

Surrey GP Dr Martin Brunet discusses whether the NHS can cope with the surge in dementia diagnoses, and why the case-finding DES should be scrapped.

Dementia: rhetoric is on early diagnosis
Dementia: rhetoric is on early diagnosis

Patients and their families often talk about the frustration they feel when there is a delay in dementia diagnosis.

It can take a while before patients and families realise there is a problem and seek help, but once the need is identified they should expect to be able to be seen in a timely manner.

The uncertainty and fear is especially great when you know there is something seriously wrong with your health, but that you don’t know what it is.

All the rhetoric is on early diagnosis, with the emphasis on finding new cases rather than removing delays to diagnosis in those already identified. The wording has changed from ‘early’ diagnosis to ‘timely’ diagnosis, but we need to have this backed up by policy that reduces delays.

There is no doubt that the dementia DES will result in more referrals to memory clinics, since that is its purpose, and without an increase in resources this will put a greater strain on the clinics.

This means that there will be longer waits for those we are currently referring, as they will be competing for resources with those who are identified by the DES – many of whom will not benefit from the referral due to having something like mild cognitive impairment rather than dementia.

The emphasis needs to be on improving access to memory clinics for diagnosis, and much better post-diagnostic support.

The GP DES could be used to encourage this post-diagnostic support instead of case finding, and we need to invest in dementia support workers in primary care who spend time with the families while liaising closely with the GP.

Currently all patients on Aricept and similar drugs have to be followed up by memory clinics and this is causing an ever-expanding case load.

With a dementia support worker the majority of these patients could be discharged to the GP, leaving memory clinics to do what they do best – which is make a diagnosis, advise on treatment and intervene rapidly when there is a crisis.

Yes, the NHS can cope – it is still one of the cheapest health services in the world – but we will need to be willing to resource it. The emphasis needs to shift from screening the well to prompt and effective care for those who need it.

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