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GPs should review all nursing home residents for dementia, says NHS England lead

GPs should screen all newly admitted nursing home residents for dementia as well as ‘double-check’ they have not missed any existing ones off the QOF register, NHS England’s dementia tsar has said today.

Professor Alistair Burns, NHS England’s clinical lead for dementia, encouraged GPs who run sessions in care homes to spend ‘an extra hour or two’ in meetings with managers to ensure no existing residents have been missed and also set up systems for having a dementia review with each new resident admitted.

The latest bid from NHS England to boost diagnosis rates and make progress on the Government’s target to improve dementia diagnosis rates comes in a blog from the dementia lead, accompanied by a frequently asked questions guide to GPs prepared with elderly care specialists.

Professor Burns said: ‘Care homes and GPs covering the homes could work together to set up a process whereby all new residents being admitted to care homes have a review to establish whether they have a diagnosis of dementia, carry out an anticipatory planning review of medication, arrange baseline blood tests etcetera. If a diagnosis is made this is recorded in the care home records and GP QOF register.’

He added that GPs and care homes ‘could work together’ on identifying patients, setting out their follow-up care plan and arranging of blood testing.

The blog post said: ‘Some care homes will have dedicated sessions from a specific GP. It might be possible to encourage these GPs to double check that all residents the GP knows has dementia are on the QOF register.

‘An extra hour or two discussing all residents briefly with the care home manager may identify people who obviously have dementia but haven’t been formally diagnosed. Most of these will probably not need referral to specialist services to confirm the diagnosis but, of course, those with unusual symptoms do need secondary care assessment.’

Meanwhile, in the accompanying FAQ, NHS England made clear that there should be no exception reporting based purely on the patients residing in care homes.

The document said: ‘Patients cannot be added to the register and then excepted because they live in a care home. Excepting from initial diagnostic tests is more justifiable than excepting from annual review so if GPs do except a lot of patients from the annual review [NHS England] area teams would be justified in seeking an explanation from the GPs for why this is the case.’

But GPC deputy chair Dr Richard Vautrey said the suggestions were ‘unhelpful’ to GPs who are already struggling with a growing workload demands from care homes.

He said: ‘When GPs first meet any patient who has newly registered they take an appropriate history which will include a review of their previous records as and when they become available, so they will be looking for new as well as current medical problems as part of routine practice. However they do this in a holistic way, not in a narrow disease specific way and it is unhelpful to suggest otherwise.

‘GPs already spend large amounts of time in care homes doing regular visits for their patients and there is little evidence to suggest that care home staff are slow at calling GPs to see their residents. It’s usually quite the reverse as care homes become increasingly risk averse. This is further adding to the growing workload burden carried by GPs and practices.’

Last year NHS England sparked controversy by rolling out a time-limited £55 per patient incentive to GPs for each new dementia diagnosis, coinciding with reports that the Government was falling behind on targets for diagnoses to cover two-thirds of the expected prevalence.

 

Readers' comments (29)

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  • GPs are ideally placed.......

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  • Guidance to help GPs ease their workload pressures and find more time for direct patient care has been published by the BMA. The guidance, Managing Workload to Deliver Safe Patient Care, provides practical steps practices can take to address rising workloads. It is not aimed at restricting patient services but finding ways of freeing up GPs’ time for patient consultations by halting inappropriate, excessive and unresourced work.

    BMA GPs committee chair Chaand Nagpaul said: ‘The demand on GP practices has far outstripped capacity, and this is having a direct effect on patient services, with longer waits for a GP appointment and many practices struggling to provide adequate essential services for their patients. This guidance gives practical advice on how GPs can focus on providing essential services to their patients and challenge some of the inappropriate and unsustainable demand on practices. Dr Nagpaul added that while these solutions would help, politicians needed to address the long-term issues of deep financial and capacity problems.

    The guidance covers:
    • Reviewing and limiting voluntary additional work, enhanced services or schemes which detract from GPs’ core work
    • Reducing clinical workload that is inappropriate for GPs or practices
    • Working with patients on management of their conditions
    • Engaging with neighbouring practices to manage workload and provide support systems
    • Making the most of new ways of working, including implementing new IT developments, such as online appointment bookings and repeat prescription orders.
    The guidance is designed primarily for GPs in England, Wales and Northern Ireland.
    The GPC is also urging clinical commissioning groups and NHS managers to support GPs by halting inappropriate workload demands. The

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  • why not get GP to do every thing under the sun once for all. Stop the drip feed and gradual demoralisation of our souls...let the zars , who barely see pts - tell everyone else what to do.... preach but don't practice!!!

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  • The screening test has poor sensivity and sensitivity.
    There's no agreed and acceptable treatment to offer.
    There's no time or resource to do this.
    The patients you're worried about are NOT, in any case, the ones in residential homes - they're the vulnerable patients living at home uncared for.

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  • So stressed out middle-aged daughter (like me and most of my friends) who has been juggling full time work, care duties and other family commitments, finally manages to get frail old Mum to agree to go into the nice care home that does have some residents that still have some marbles, that doesn't feel like a jail and where the residents can go out on outings. GP comes along, decides that the mild cognitive impairment is "dementia" and Hey Presto, the home is not sure if they can stay because they do not take EMI residents. Who benefits here, Prof Burns?

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  • Usually when visiting an nursing home its impossible to distinguish the demented residents from the demented staff!

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  • Bravo 4.14. Bravo. Biggest laugh of the day.

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  • Has the National Screening Committee evaluated this proposition?

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  • Just what everyone in a nursing home needs, another diagnosis to go with the 6 they no doubt already have. And an incurable one at that. Seems sensible, I'm sure everyone would appreciate to know they have dementia for their final 6 months of life.

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