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Dementia tsar admits mistakes in enhanced service

The Government’s dementia DES ‘did not get everything 100% right’ in terms of the screening process of patients in at-risk groups, its leading adviser has admitted.

Speaking at a Westminster Health Forum event on dementia policy, dementia tsar Professor Alistair Burns said he hoped changes to the dementia DES - which will be introduced with the new contract for 2014/2015 - would ‘put GPs back in the driving seat’.

Professor Burns’ comments came after a Pulse survey of GPs revealed a fifth of patients were unhappy about being asked if they are willing to be screened.

NHS England has said changes in the enhanced service will ‘allow greater professional judgement in which patients should be offered assessment to detect possible dementia’.

Under the DES, GPs are expected to opportunistically bring up the offer of an assessment for dementia in patients identified as being ‘at risk’, including: those aged 60 and over with cardiovascular disease, stroke, peripheral vascular disease or diabetes; patients aged 40 and over with Down’s syndrome; other patients aged 50 and over with learning disabilities; and patients with long-term neurological conditions. 

NHS England is continuing with the dementia DES in next year’s contract as part of the Government’s national dementia strategy aimed at improving diagnosis rates.

But GPs have raised concerns about the potential harms of overdiagnosis resulting from screening, as well as long waiting lists at memory clinics and a lack of post-diagnostic support services.

Professor Burns defended the DES, insisting it was a case-finding approach and not straightforward screening with targets, but said the key focus was now on improving post-diagnostic support for patients.

He reaffirmed his vision to see dementia ‘recast’ as a long-term condition that should be primarily diagnosed and managed by GPs in primary care, outlined in an interview earlier this year.

Asked by Pulse about the plans to reform the enhanced service and introduce more professional judgement on when to offer screening, he said things ‘need improving’ and that ‘we don’t always get these things 100% right first time’.

Speaking after the seminar, Professor Burns said the changes to the enhanced service had not been agreed but said it was part of plans to give GPs and primary care clinicians a bigger role in diagnosing and managing dementia overall.

He told Pulse: ‘It’s not finalised yet and that’s a private negotiation between NHS Employers and the BMA - but one of the aspirations is that we make it so we’re putting clinicians in primary care in the driving seat.’

Professor Burns said it was crucial for GPs to be able to use their judgement in how and when they ask about dementia, in line with the approach specified in Commissioning for Quality and Innovation (CQUIN) goals for dementia – and insisted the DES was not about ‘tick box’ screening to reach targets. 

He said: ‘If you look at the question in the CQUIN – the hospital one – it’s ‘has the person been more forgetful in the last 12 months to the extent that it has significantly affected their daily life?

‘And it’s also the way you go about it – is there anything from what the family says or other issues that makes me think that you might have a poor memory.

‘This is not about ticking a box, this is not some sort of target.’

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