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Inappropriate GP dementia referrals double since introduction of case-finding DES

Soaring numbers of patients without dementia are being caught up in the PM’s diagnosis drive, with over half of those referred by GPs to memory clinics turning out to not have the disease, experts have warned

Neurologists in Sheffield have warned of potentially ‘devasting’ consequences for patients as over half (52%) of patients referred to them for confirmation of a diagnosis of dementia after the introduction of the case-finding DES in the 2012/13 GP contract had psychiatric or functional memory problems, but not dementia.

This compared with a rate of 25-30% previously.

The warning comes as the Government announced plans to step up the Prime Minister’s Challenge on dementia, including a new six-week waiting time standard for patients referred by their GP to a memory clinic.

But the Sheffield neurologists warned that the PM’s project was picking up lots of patients without dementia, despite recent data showing a 10% jump in the number of people placed on the dementia register following a scheme to pay practices £55 per additional dementia diagnosis since last autumn.

The team of neurology consultants from Sheffield Teaching Hospital and the University of Sheffield looked at 150 referrals and showed that this boost in diagnosis rates may have come at a cost.

Writing in a letter published in the journal Age and Ageing, they said that the Government ‘may not achieve its targets in reducing the dementia gap, will increase the strain on GPs and memory clinics [and] may adversely affect waiting times and the provision of good-quality post-diagnosis care and support for people with dementia and their families’.

It added: ‘Not only are we concerned about not reducing the [dementia] gap, but the incentivisation of diagnoses of dementia has the potential to make things worse… [I]ncreased referrals of people with cognitive complaints not due to neurodegenerative dementia… creates a risk of false-positive diagnosis, which can have a devastating consequence.’

Dr Daniel Blackburn, one of the neurologists, told Pulse GPs had been put in ‘a difficult situation’. He said: ‘We already know there are long waiting lists to be seen and if you send more people who don’t have dementia into those clinics… it slows down the process. But also I think there is a risk that if we don’t analyse patients carefully enough then we are going to give people a false diagnosis.’

He said he and his team would ‘urge GPs to think carefully about any history of mental problems’ when making their initial assessment but he added: ‘[GPs] are in a difficult situation. It is a hard diagnosis and because of time constraints they can only do a small amount of screening tests that don’t work terribly well.’

The consultants noted that their findings backed Liverpool neurologists, who last year reported most of the large increase in referrals to their memory clinic were for individuals with subjective memory impairment, frequently among ‘the worried well’.

It comes as Government’s 2020 aspirations for its dementia strategy included ‘people with dementia having equal access to diagnosis as for other conditions, with an expectation that the national average for an initial assessment should be six weeks following a referral from a GP (where clinically appropriate), and that no one should be waiting several months for an initial assessment of dementia’; and ‘for GPs to take a leading role in ensuring coordination and continuity of care for people with dementia, as part of the existing commitment that from 1 April 2015 everyone will have access to a named GP with overall responsibility and oversight for their care’.

The dementia DES, which is still running and pays practices for screening ‘high risk’ groups for memory problems, was opposed by some GPs on its rollout including running a campaign calling for its boycott.

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Readers' comments (22)

  • With this goverment the woods are full or bear excrement.Thats what happens with politiacl interference.Well done posh boys.

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  • We fall into their trap once again making us all look like a bunch of money grubbing,incompetent nincompoops.

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  • Quelle surprise!
    There were one or two people saying it would do more harm than good, myself included!

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  • Utterly shabby - up there with the worst of them.any record of how many refused to be referred or how many medics refused to use them as cash cows

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  • I think this is a consequence of the "screening" DES rather than the "cash for diagnosis" DES. Both are ill-conceived, the latter is too recent to have had such a significant impact on the data.

    With the earlier DES there was no financial incentive for referring or diagnosing - I think this just reflects more 6CITs being done, more coming back raised, and more patients being referred. It's just a screening tool and if patients have low mood or a reversible causes we don't have to refer.

    It's a six month wait for a neurology outpatient appointment in our area, which is covered by Sheffield. I'd like to see capacity increased there but it seems like suspected epilepsy, MS, cluster headaches etc. aren't a political priority.

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  • Vinci Ho

    You see ,
    Darth Vader and Agent *unt are both idiots. All they care is the wonderful headlines of how much this government had done for dementia.
    Carpet screening to race to the finishing line at the end of March to have that 10% rise in diagnosis . Both primary and secondary care colleagues are overstretched beyond limits by this bullying and autocratic regime.

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  • i do not disagree with the idea of over diagnosing dementia being harmful. I think we should only be diagnosing it if there is a benefit for the patient and the patient wants to pursue a diagnosis.

    But I think generally, if 50ish % of referrals to a diagnostic service actually have the condition - that is a pretty good outcome.

    For reference 10ish% of 2ww referrals have cancer. And the threshold for 2ww is dropping from 5% to 3%.

    Who decided that 50% is inappropriate?

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  • right here we go ...

    prediction time -

    1. naming and shaming of practices who overdiagnose with helpful online search rankings ,
    2. thereafter 'have you been misdiagnosed with dementia?' - write in to the Daily ****

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  • Dementia is more common than you think. The electorate seems to have forgotten that they put the pack of idiots in Parliament into Parliament. Thus we have a nation with dementia. Why doesn't Government just put an extra 3 billion into Primary Care?

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  • Una Coales. Retired NHS GP.

    The government is working with the RCGP.

    Having fallen for the trap, that now many GPs are unable to diagnose dementia correctly, it may be all plans go ahead for a fourth year of mandatory GP training to cover psychiatry, ie have a GP trainee cover hospital psych shifts for min wages and all GP trainees pay an additional year of AiT subscriptions to the RCGP?

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