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Gold, incentives and meh

GPs should be sued for ‘late’ dementia diagnoses, says professor

A leading academic has called for patients to sue GPs for failing to diagnose dementia, arguing that ‘the sooner someone sues a GP… the better’.

Professor June Andrews, director of the Dementia Services Development Centre at the University of Stirling, made the comments in the Letters section of the London Review of Books, in which she said the ‘sooner someone sues a GP for failure to diagnose as early as possible, the better’.

Sha also dismissed GP critics’ concerns about the £55 ‘cash for diagnosis’ scheme introduced by NHS England last October in a bid to boost dementia diagnosis rates.

Professor Andrews was responding to an article from GP Dr Gavin Francis, in which he explains his motivations for signing an open letter that called for the £55 per diagnosis scheme to be withdrawn.

In her response, Professor Andrews wrote: ‘Gavin Francis supports GPs who don’t diagnose dementia because they think there’s no point. It is outrageous that publicly funded professionals could withhold important information about my health.

‘It’s all very well being professionally insulted by the Government’s offer of £50. The sooner someone sues a GP for failure to diagnose as early as possible, the better.’

Professor Andrews said that ‘significant financial and emotional damage and unnecessary disability can be avoided’ from early diagnosis, but pointed out wild variations in diagnosis rates, from 20% in London to 75% in Belfast.

She added: ‘Francis says “presumably” the Government thought low diagnosis was evidence of poor care. If anything, it is evidence of no care at all. But that will be for the lawyers to prove.’

Professor Andrews is described on the University of Stirling website as ‘a recognised leader in the world wide movement to improve services for people with dementia and their carers’ who has won international awards and previously set up and directed the Centre for Change and Innovation in the Scottish Executive Health Department.

According to the website entry, the Dementia Services Development Centre she now directs was set up to ‘devise and implement interventions to drive change in clinician behaviour and health and social care organisations in order to achieve the ambitions of national dementia strategies in the UK and beyond’.

Readers' comments (94)

  • Obviously a 'professional' who suggests recourse to legal action may not be particularly competent . I don't think she has done herself any favours despite having some bravery in coming onto the forum.

    I don't work in dementia but there has been a big drive in my area to involve patient groups and university researchers in pushing products. I like to think in my field that is for good reason because often we are not using some products which have evidence based benefits purely for short term cost reasons.

    That cannot be said for dementia, we have nothing in the pipeline, there is work on some immunotherapy approaches but active clinicians will hear about the trial evidence before I probably will.

    To ask campaign for improvement in resources and quality of care is in everyone interest. Malignant and malicious comments about the primary care profession is not helpful.

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  • Dear Prof Andrews
    I know you mean well and you are only trying to get the best for a group of people who have been historically neglected. However, it is highly inflammatory to suggest GPs should be sued for not diagnosing Dementia early enough. It fuels the current trend to blame a group of professionals, who work bloody hard to look after ALL of their patients, including those with dementia. Most GPs, including myself, take the responsibilities of job very seriously. If some of us are in no rush to formally diagnose dementia, it is because things are never black and white, and formal diagnoses often dont help situations and in some cases, can make things much worse. 25 years ago, my father was diagnosed with vascular dementia. Knowing what was coming did not help him. It made him highly anxious and depressed. He was only 55 when diagnosed and the biggest problem he and my mother had, was finding the right social support to help the both of them cope. Because he was under 60, many services then would not even consider helping him, as he was too young. Things have come on leaps and bounds since then and thankfully there is much more help out there to help people with complex health needs, both young and old. However, none of these things are dependant on official diagnoses, nor should they be.
    Please. Please dont beat and already beaten profession with threats of suing them, but use your influence to improve services and awareness of things that can help people, rather than inciding litigation on a group of people who are not deliberately withholding diagnoses from people, but who are rather trying to manage the whole person AND their whole population over a vast array of diseases. If more GPs continue to leave the profession thanks to new threats like this, what exactly do you thing dementia diagnosis and treatment will be like then?

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  • The professor nurse should be ashamed for these inflammatory comments and should be referred to the NMC for bringing the whole of the medical profession into disrepute. Can she stick to telling people who work like her how to do their job rather than people much more qualified in diagnosis and management of dementia? Shame on you. Thank you the nurse who commented about how ashamed you feel about her for your support . The "professor" needs to take a good hard look at herself in the mirror.

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  • One would expect a responsible attitude from a 'Professor' and not a whimsical 'Sue a GP...' so I am proved right.
    Probably you forgot to add that this is Cameron's agenda and it's election time. I, on the other hand, although in favour of diagnosing everything in time - not just the government lead drive for dementia, as a hardworking GP can only say you and your entourage can buzz off to Mars with your stupid bullying and pressurizing GPs.
    Have you been promised a Directorial post after elections?

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  • ''The main messages of support I've had are from quiet people. signed June Andrews.''

    I wonder what that meant.....? People who are not saying anything,,,,,mmmm, or are we talking about auditory hallucinations.

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  • It is welcome that Professor June Andrews is engaging in discussion.

    I have met Professor Andrews several times and I know that she is a passionate advocate for those living with dementia. However I do not agree with her on early diagnosis of dementia, and never have. Professor Andrews is aware of our differing views on this. I have advocated for a timely approach to diagnosis and was delighted to see this enshrined in the “Glasgow Declaration” in October 2014. This declaration has now been signed by 50 dementia organisations across Europe.

    I am afraid that the suggestion by Professor Andrews of adding in a "stick" (threat of legal action) in addition to the £55 "carrot" seems hugely misguided to me and potentially most harmful.

    I have covered this here: "Can't - Won't - No point"

    I work in NHS Scotland and was concerned about the target based approach Scotland took. This approach WAS incentivised (but not at GP level) as NHS Boards were paid for reaching the target. I must correct Professor Andrews on this. The target was specific and asked for "Early diagnosis". In my experience the target skewed behaviours in unethical ways and at all levels: from senior managers and right through the clinical “chain”: as a result, my experience was that the consultation no longer seemed to belong to the patient and doctor. Rather a political target loomed over both.

    Scotland was TRIUMPHANT (!) about reaching the target and in giving evidence to Westminster parliament chose to shame the rest of the UK. This was the beginnings of maps and targets rather than patients and patient-centredness.

    As Dr Brunet has pointed out target rates are very crude and the ‘dementia prevalence-calculator’ implies scientific and epidemiological accuracy though it has (to my knowledge) never been studied in any academic detail (at least independently) before being implemented as the guide to policy in NHS England. This is an experimental approach. Delayed diagnosis of dementia is a complicated issue. Surely the better approach is to support and encourage professionalism in our profession rather than target (and I use this word correctly in this case) our GP colleagues.

    The approach that Professor Andrews forthrightly advocates risks inappropriately medicalising swathes of our elderly. Age-related cognitive changes are real (distributed on a parabolic curve) and should not be treated as dementia. The risk is that care for those living with dementia worsens as services get stretched as a result. I am sure Professor Andrews does not wish this. In my opinion, inverse care is a very real risk.
    I worry that we are adding great fear about all this through simplified "awareness" campaigns (I am of the view that the Big Dementia Charities carry much responsibility here). I feel that Prof Andrews approach, as a high-profile and international expert, also risks this.

    Lastly, whilst I very strongly disagree with Prof Andrews on this matter, I respect her as a person and do understand that she has a good heart. I just think that Professor Andrews has not thought through the complexity and the ethics of the doctor-patient relationship which is far more important than any crude target.

    Dr Peter J Gordon
    NHS Scotland

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  • Wow!
    Amazing debate

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  • Ah, nurse! Clearly lacking in insight.

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  • How can any doctor encourage a patient to sue a colleague without full knowledge of the consultation that took place?

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  • I respect Peter Gordon's defense of June Andrew's character.

    However she has crossed the line with demands for medical colleagues to be sued. I only hope the NMC are able to take some appropriate action.

    A formal written apology should be be a reasonable starting point.

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