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GPs hit by widespread complaints from patients 'unhappy' over dementia screening

Exclusive GPs across England are facing complaints or objections from patients who ‘resent being asked’ about symptoms of dementia as part of the controversial case-finding DES, a Pulse survey reveals.

A snapshot poll of 501 GPs in England who are taking part in this year’s DES has found that around one in five - 21% - have seen patients protest about the process, which involves asking those considered at risk if they are concerned about their memory.

The survey also shows almost two-thirds of GPs are experiencing longer waiting times at memory clinics since the introduction of the DES.

The DES – which aims to facilitate timely diagnosis and support for people with dementia - was introduced in April as part of Prime Minister David Cameron’s 2012 ‘challenge on dementia’.

Under the DES, GPs are encouraged to make opportunistic offers of dementia assessment to at-risk patients where they consider it appropriate.

If a patient has suspected dementia, GPs are mandated to refer them to specialist services, such as a memory clinic, to confirm the diagnosis, then provide treatment if necessary and give advice and support to the patient’s carer.

But many GPs opposed the introduction of the DES, warning at the time that it could cause undue anxiety in patients and that support services would be stretched, with some launching a petition.

As part of the recently announced 2014 GP contract deal, NHS England said the DES would be changed to allow ‘greater professional judgment in which patients will be offered assessment to detect possible dementia’, while the BMA said there will be a new requirement to offer advanced care planning to patients who are diagnosed with dementia. 

But many GPs currently involved in the DES and responding to Pulse’s survey said they had encountered patients upset with the scheme as it stands.

Dr Zishan Syed, a locum GP, said: ‘Patients feel it is a tickbox exercise.’

‘The main issue really seems to be centred around what the consequences of a such a diagnosis is and what is actually available to help patients. In one case, the family member was quite frustrated at the length of time taken for a family member to go to a memory clinic and the actual treatments that were given during visits there. The expectations of the treatments and the little benefit when consumed or taken were vastly different. Consequently the faith in this screening by that person for themselves and other friends and relatives was actually very low as in their view it did not help at all.’

‘I think a lot of GPs share this worry - that there seems to be a political drive to push up prevalence levels for the sake of numbers and the care of patients suffers consequently as expectations of treatments do not actually match the results of the treatments that are currently available.’

Other GPs who responded to the survey said they had also dealt with complaints. Dr Roger Neal, a GP in Toddington, Bedfordshire, said: ‘Patients resent being asked’. Dr Ian Ewart, a GP in Guildford, Surrey, said patients were ‘generally unhappy to be asked, if they have no problems’.

Dr Frances McWilliam, a GP in Settle, Yorkshire, said the whole exercise appeared to be of little benefit: ‘This DES seems a particularly odd use of resources - where is the evidence for hordes of patients with undiagnosed significant dementia that need screening for it and in whom diagnosing it early will make any difference to them?’

The survey also identified fears over increased waiting times.

Some 17% of the 498 GPs who answered that question said waiting times at memory clinics had become ‘much longer’ since the introductionn of the DES, while a further 41% said they had become ‘longer’. Around a third - 38% - said they had stayed the same.

Dr Alan Sykes, a GP in Beverley in east Yorkshire, said: ‘Why screen for more cases when there is nowhere to assess and treat them? Total madness.’

Dr Rachael Kenyon, a GP in Penzance, Cornwall, said: ‘The wait was very long prior to the DES. Now it’s ridiculous.’ Dr Ian King, a GP in Redhill, Surrey said the waiting time in his area was typically around eight weeks. ‘That is about double last year,’ he said.

Commenting on the Pulse survey findings, Dr Ian Greaves, a GP in Stafford who has pioneered an anticipatory care scheme for dementia patients, said: ‘The DES is a bit of a sledgehammer to crack a nut. Unless you have post-diagnostic support in place it’s a bit of a blunt tool.’

‘At the moment, it’s just a Government policy which doesn’t make much sense without doctors getting behind it and making it work in the way they support patients after diagnosis.’

He added: ‘Some people don’t like being asked, so you do have to be sensitive, even kind, and pick your moment when asking patients questions - not just be doing it in order to meet targets.’

NHS England was approached for comment but did not respond ahead of publication.

Survey results in full

Have you had any patients complain about being screened for dementia as part of the DES?

Total answered - 585

Do not take part in the DES - 84

Yes - 107 (21% of those who take part in the DES)

No - 394 (79% of those who take part in the DES)

Since the dementia case-finding DES came into effect in England in April, have waiting times at your local memory clinic become:

Total answered - 498

Much longer - 83 (17%)

Longer - 205 (41%)

About the same - 192 (38%)

Shorter - 13 (3%)

Much shorter - 4 (1%)


About the survey

Pulse launched this survey of readers on 15 October, collating responses using the SurveyMonkey tool. The 26 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung Tab 2 tablet as an incentive to complete the survey.

As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. GPs were also asked on a voluntary basis to provide their GMC number and 567 of the 673 GP respondents who answered either question did so, although these were not verified or used to screen out respondents.




Readers' comments (15)

  • Another academic/public health/ivory tower inspired "great idea" that has not been thought through and merely creates anxiety and unnecessary work.. Focussed screening I have no problem with and of course for those (or their cares) that ask. Hopefully will go with the new contract deal.

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  • We have become a totally spineless bunch. Thank you GPC. I wonder what the consequences would be if the GPC asked GPs if they wish to stay in this crazy system or leave like dentists. They cannot see that even the USA cannot get primary care physicians. We just get walked over. When oh when will we learn to say enough.

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  • GIVING a patient a curse of diagnosis of dementia and then telling them there is no cure was never a good idea.
    i always disliked fortune tellers. why do you want to know what bad things will happen 10 years on and may never happen.

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  • Nobody ever listens to the grass roots of GPs who were saying things along these lines would happen when they imposed this on us.Despite our large practice signing up for this I have refused to screen for dementia unless it was clinically needed.

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  • The whole idea of Dementia screening is ridiculous, if you know anything about screening. This is not an idea that has come from academe, but from the pet projects of politicians, whose ignorance is only matched by their duplicity and venality.

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  • 'Dementia sufferers 'abandoned', says Jeremy Hunt
    Doctors are refusing to test for dementia because they think it is pointless while no “cure” is available, the Health Secretary Jeremy Hunt says'

    all complaints to ...

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  • The response from our local psych consultant seems to have changed significantly since this came in. The majority of referrals seem now to be told "This appears to be vascular so nothing I can do & refer back to GP" whereas previously many more were closely followed up & more often diagnosed with Alzheimers.

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  • The first comment on the above article explains far better than I could exactly why I will not take part in this DES.
    Thank you to a very brave lady.

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  • For goodness sake leave the NHS. GP has become a sick joke. Stop colluding with those who have destroyed the profession. Follow the dentist's lead.

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  • Ivan Benett

    There is a clear case for early diagnosis of dementia or cognitive impairment. People with cognitive loss get ill quicker, slender more time in hospital beds and are less likely to return to their home on discharge. Although we can't 'cure' in the usual medical model way, we can make things better for the individual and their carers.
    This involves an integrated care approach between ourselves, secondary care, social care and voluntary sector. Our bit is to make sure all are involved, medical risk factors, balancing prognostic benefit with risk of harm such as polypharmacy. We can intervene earlier to stop decline, unusually from simple infective episodes.
    Those anonymous contributors who wish to leave the NHS -Cheerio. Do let us know how you get on. Send me a postcard. I'm staying to make sure it works despite the constraints. Oh and can we have our money back - the money we taxpayers spent on your training.

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