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GPs begin campaign against dementia screening DES

GPs have begun a petition to urge the Government to think again about its plans to rollout dementia screening in primary care.

The petition warns screening could lead to unnecessary distress for patients, potentially causing anxiety and depression, while there is no known cure for the disease.

The Department of Health proposes to launch a new DES for practices to assess all at-risk patients for signs of dementia, funded by the removal of QOF points from the organisational domain.

But a group of over a dozen GPs and some other health professionals are urging the Government not to go ahead with plans through an online petition that has garnered nearly 200 signatures in only two days.

Dr John Cosgrove, a GP in Birmingham, said the plans could harm patients more than it will help them.

He told Pulse: ‘We would certainly want people to be diagnosed when it is right for them, which is probably when they present symptoms, but we have issues with screening the asymptomatic.

‘In particular there is no effective treatment to alter the progress of the disease and there is no consideration given to the potential harm of the screening programme.

‘To foist a test on people without their informed consent is wrong.’

Under the draft terms of a DES worth £3,600 per practice, GPs will have to assess all patients over 75 and those aged over 60 years with risk factors such as cardiovascular disease, diabetes, learning disabilities or long term neurological conditions, such as Parkinson’s disease.

 

Readers' comments (11)

  • What a bizarre campaign.

    - Dementia underdiagnosis is a recognised problem.
    - Patients who do not wish to be screened can refuse it under informed dissent.
    - The view that there is no useful treatment is out of date, but even if true it would allow patients to prepare whilst they are still able.
    - A diagnosis of dementia allows access to a wide range of support services both for diagnosed patients and their carers.

    Or should we just rely on secondary care to diagnose the patients after they're admitted to secondary care and cannot be discharged?

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  • In respone to David Palmer:

    No doubt screening for many conditions will improve the care for the few cases picked up. I don't think many would argue that. The question surely is how is this 'shoehorned' into the working day.

    I can think of no end of things GPs could look for and check. In cannot think of a single idea to increase the length of a working day.

    I retire soon so good luck to those who remain. xx

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  • There are clear criteria for screening programmes set by the WHO. See here
    http://en.wikipedia.org/wiki/Screening_(medicine)

    This programme fails to meet:
    2. There should be a treatment for the condition.
    9. The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole.
    10. Case finding should be a continuous process, not just a once and for all project.

    It is shameful that by putting money into projects that are not appropriate, money is being diverted from interventions that can/ will make a difference. It makes it that much harder to explain to a patient why the drug they want is not funded.

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  • In response to anonymous 14 Dec, your comment is more about prioritising areas/resources, whereas the story above seems to argue that screening is actively harmful to patients.

    Perhaps the campaign could benefit from a little clarity, unless this is another case of the Pulse headlines not quite matching the story...?

    PS. Best wishes for your retirement, I think we're all a little envious and will need that good luck!

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  • Try asking your friends and family whether they would personally want to know if they had dementia early. I have done, and the firm answer is - 'No, I would rather melt into ga ga land without really giving dementia my full consent to take over my life. Then the issue is for my carers, not for me'. Why doesn't Pulse try out the a quick poll?

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  • Where can I sign up?

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  • David Bush

    Here...


    http://epetitions.direct.gov.uk/petitions/43126

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  • In response to sunita berry

    Twenty or thirty years ago of you'd asked your same question about cancer diagnosis you may well have had similar answers to your question. People not wanting to know the inevitable that would follow.

    Ours views (very rightly) have changed on this. Every person should have the right to a cancer diagnosis. Our care now for cancer patients has improved dramatically over the years.

    I believe we are in a similar situation with dementia. Either bury your head in the sand or demand an attitude change and see then see dementia care improving.

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  • *anonymous, I am under the impression that whilst there is not a 'cure', cholinesterase inhibitors do reduce the impact of symptoms. There is also a strong case for early social and support for dementia sufferers.
    There is plenty that this government is doing wrong that GPs should be campaigning against, this is not one of them!

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  • As with cancer screenings, the information to clients will be inadequate, and biased towards acceptance; the conditions under which consent is sought, if it is, will be pressured; and the clients will not grasp that a doctor could possibly offer them something that may harm them - it may harm this client because it will harm some clients. There is no good evidence that it will help any clients. As with all screenings, there will be false negatives, false positives and overdiagnosis - diagnosis of mild cognitive impairment not destined to progress to dementia, and there will be many of these for every correctly diagnosed person – if we even have a concept of correct diagnosis of early dementia, which is doubtful. As with cancer screenings, there is inadequate evidence of benefit of screening for dementia, and the benefit, if any, has to be worth risking being overdiagnosed and medicalized unnecessarily, a value judgment only the individual can make, not the government, not the GP, and they won’t be in a position to do that if it is sprung on them during a consultation for something else. It will just cause widespread irreparable distress, and the health professional causing that has to believe that the distress they cause to many is nothing compared with the imperceptible benefit to some other person.

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