GPs could face increased targets for dementia diagnosis
GPs are set to face increased targets for diagnosing dementia patients, despite reports that some patients are already waiting as long as nine months for memory clinic appointments.
The Alzheimer’s Society has launched a revised ‘Dementia UK’ report - the first version of which formed the basis for the Government’s dementia strategy - which it claimed shows the burden of dementia is rising and could reach over two million by 2050, with one million undiagnosed ‘unless action is taken’.
The Society said that the target for diagnosis should be increased from two-thirds of the 800,000 estimated to have dementia, to 75% by 2017. It also called for the Government to introduce a maximum waiting time from GP referral to diagnosis of 12 weeks - highlighting that in some areas patients are enduring 40-week waits.
But GP experts questioned the predictions of the burden of dementia, and said that increasing the target was likely to exacerbate the pressure on memory clinics.
The charity, which launched the report today, said that the current target of 66% of the 800,000 people estimated to have dementia - which was set out by the Prime Minister’s Dementia Challenge initiative last year - was unlikely to be achieved by 2015.
The Alzheimer’s Society was influential in guiding the Government’s national dementia strategy, with its work on prevalence and under-diagnosis a key driver of the dementia case-finding DES introduced in the GP contract in 2013.
However, the DES – requiring GPs to offer to screen at-risk groups and refer people with memory impairment for formal assessment at a memory clinic – was widely opposed by GPs, with many arguing it was not evidence-based and would lead to anxiety for people who could end up with a diagnosis before they are ready, and without the necessary support services in place.
The new Dementia UK report includes a new consensus statement, developed by an international panel of experts including the Government’s dementia tsar Professor Alistair Burns, which puts the current prevalence in people over 65 at around 7% - the same as in 2007 when the group last reviewed the evidence, and corresponding to the Government’s previous prediction that around 800,000 people in the UK are living with dementia.
The report says that due to the ageing population that number is steadily climbing, set to reach 850,000 people by 2015 and around 2 million by 2050, half of whom will not have a diagnosis unless ‘action is taken’.
On the basis of this the Alzheimer’s Society says that the target on diagnosis should be increased. It said: ‘[The Government] should prioritise: A 66% dementia diagnosis rate across all areas so that people do not miss out on the support currently available - with a commitment to reach 75% by 2017; no-one to wait longer than 12 weeks from seeing their GP to diagnosis; a guarantee that everyone has access to a dementia advisor or equivalent following a diagnosis to help them live as well as possible at all stages of the condition.’
The charity’s chief executive Jeremy Hughes said the new prevalence figures back Government’s claims GPs are under-diagnosing the condition.
Mr Hughes said: ‘While in recent years there has been a small improvement in dementia diagnosis rates, a postcode lottery still prevails. Everyone with dementia should have access to the certainty of a diagnosis and the right support to come to terms with and manage the condition.
‘If we do not see a nationwide effort to improve diagnosis rates we could see more than a million people living with dementia without a diagnosis by 2051.’
Mr Hughes told Pulse it would take longer for the goal of two-thirds of people with dementia diagnosed to be reached than originally hoped, and conceded some patients were having to wait 40 weeks for a diagnosis.
Mr Hughes said: ‘The average goes up to something like a 40-week wait in some parts of the country. In the best-performing parts it is within a 12-week period, so what we’re saying is everywhere should get to the level of the best-performing areas.’
However, Professor Steve Iliffe, professor of primary care for older people at University College London, said the report’s estimates presented a ‘worse-case scenario’ and raising targets would not help patients.
Professor Iliffe said: ‘The consensus prevalence figures are now presented as the worse-case scenario not as the expected outcome, so the authors have hedged their bets a bit. Previously it was presented as the epidemiological prediction – it was a much firmer statement of what is likely to happen.
‘I don’t quite understand why we need targets for this – we may well want to see many things improve around the timing of diagnosis, but saying we want to go from 66% to 75% of a figure that is unclear and may be going down is a bit odd.’
He added: ‘What we’re seeing is the silting up of memory clinics with people with subjective memory complaints who have probably not got dementia. You’re creating a problem that can only be solved by throwing more money at memory clinics – and the money has got to come from somewhere.
‘The problem is in some ways being made worse and if you take money away from support of people with advanced stage dementia to increase the numbers of people going into memory clinics that may be creating an inverse care law – the more you need the less you get.’
Dr Martin Brunet, a GP in Surrey who was among a number of GPs who campaigned against the dementia screening DES, said it was unclear how the consensus group had arrived at their estimates of prevalence and the figures should not be used to develop targets for diagnosis.
Dr Brunet said: ‘It’s a bit surprising given the CFAS II study is so significant, that the prevalence is not deemed to have changed. The problem is they are going to use this figure to set target diagnosis rates and the ethics of giving doctors a target for diagnosis has never been looked at properly.’
He added: ‘To hit the target you don’t have to make the right diagnosis and you don’t have to give patients any support, you just have to hit that target. And if you encourage more and more people to be diagnosed and you don’t put any extra money into support then it’s no surprise it all gets more thinly spread.’