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GPs go forth

GPs have ‘three strikes’ policy before willing to refer for dementia, Alzheimer’s chief claims

GPs have a ‘three strikes and you’re in’ policy on referral that is delaying people with dementia getting a diagnosis, the head of a leading charity has claimed.

Alzheimer’s Society chief executive Jeremy Hughes told a packed King’s Fund conference on dementia that it was a standard policy for GPs not to refer patients until they came back for the same thing at least three times ‘to manage budgets’.

Speaking at the Leading change in dementia diagnosis and support event, Mr Hughes claimed resources were being wasted in diagnosing dementia because GPs ‘have a three-strike and you’re in policy’ whereby ‘you have to go to the GP at least three times for the same thing before they will refer you’.

He went on to add that a ‘GP friend’ had told him ‘GPs are taught to do this, to manage the budget’.

Dr Hughes said this meant people with dementia were not being diagnosed in a timely way, with some having to go many more times before being referred for assessment.

He said: ‘We have people with dementia who had to go five or six, even eight or nine times to the GP, and were then referred to a memory clinic. We have to ask, is this a good use of resources?’

It comes the day after Pulse reported that experts were warning that 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.

Readers' comments (16)

  • Tosh - suggest he gets some new GP friends.

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  • GP consultations are;
    1) To see GP to get the ball rolling
    2) For GPcog scoring.
    3) For blood test
    4) for ECG.
    5) for review and referral.
    So yes 5 visits to the GP practice is the norm primarily because the bloody memory clinics wont see them without pointless blood investigations and ECGs and that they wont undertake themselves.

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  • @5:27

    It would be interesting to audit what the positive yield is from those memory clinic investiagions.

    Personally I don't recall ever having once found a reversible cause for ongoing memory loss (except maybe alcohol, but when I've diagnosed that it hasn't been through bloods and ecg!)

    What is other peoples' experience?

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  • Typical of the approach of such charities/pressure groups at the moment. They have the wind in their sails as the government is supporting them.

    Who needs evidence to back up these sort of assertions - all you need is an anecdote from 1 GP!

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  • Yet more unsubstantiated allegations ridiculously accepted as general truths and used to denigrate GPs. @5.27 is right in terms of what we do and these are actions, not delaying tactics. Perhaps this is what "GP friend" meant by managing the budget as these tests are cheaper when arranged by +/- carried out in primary care.

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  • I would quite happily say this is nonsense. If I think a patient has dementia, they get GPCOG'd at the time, bled shortly afterwards, and referred with their permission depending on their results. I would say 2 visits tops. He needs to get his facts right. I don't remotely think about budgets if a patient is in need of a treatment (except for prescribing). Complete and utter nonsense.

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  • Doesnt this charity have the ear of the government and a close association with certain drug companies hence coming out with unsubstantiated nonsense would be par for the course.We are now the whipping boys of charities as well.If they want to paint us into a corner they have got it coming to them when the primary care collapse hits home.I personally cant wait for the collapse of the NHS.It may then be down to if people can pay.Mr Hughes go and have a think tank,come up with more rubbish!

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  • Ouch! It seems to be memory clinic bashing time again just when we are already being severely thrashed for not having reached our quota of dementia diagnoses. Here is the case for the defence m’lud.
    @5.27 raises a valid point about reversible causes or the lack thereof. They occur rarely and more often than not there are the usual culprits such as B12 deficiency which, whilst not the primary cause of the memory loss, can muddy the waters and if not treated can make an accurate diagnosis that little bit more difficult. Many memory clinic nurses have long raised the issue of the necessity for such tests, but as we all know, many consultants don’t like their practice to be questioned by their minions, hence the status quo.
    As for the subject of ECGs, it is policy that we never ask for them prior to seeing the patient as they aren’t of any help in diagnosis; we do our own if we intend to start treatment, to rule out any cardiac conditions which may contraindicate prescribing. In doing so, we have detected many cases of previously undiagnosed cardiac disorders.

    Mr Hughes is a numpty if he thinks that GPs wait and wait until they refer. He only needs to take a look at our diagnostic rates and see that our MCI and no-memory-problem-at-all figures run at approximately 30%. I suspect that this is due to the pressure being placed on GPs to raise their dementia numbers, thus, often the slightest whiff of a memory problem results in a referral to the memory clinic, (hands up who hasn’t left a pan on or forgotten what they went upstairs for?)
    I spoke to a patient recently who told me that he had been called in the middle of the day by his surgery, with which he had had no contact for 12 months (he hadn’t needed it), and was told that as he had just turned 65 they would like to do a memory test, over the phone. Before he knew it, he was invited to the surgery for bloods and ECG and then promptly landed on our doorstep without being seen by his GP to discuss a referral or obtain his consent for doing so. As it was, he scored within the normal range on the neurocognitive tests, was living alone perfectly independently, his only crime being a very mild, non-progressive memory problem since his stroke 7 years ago. Perhaps if his GP had actually checked his records beyond looking at his DOB, or had had the courtesy to see him, we could have saved one and a half hours testing and history taking, an MRI scan, a consultant appointment, not to mention the anxiety it must have caused, only for us to say this poor chap definitely didn’t have dementia. This was probably a rare example of very bad practice, but surely as a rule, a few sensible questions might prevent GPs from inundating us with people who clearly don’t have dementia and then berate us for our lengthy waiting times.
    As the general election approaches and the issue of dementia becomes an even bigger political hot potato, I can only imagine matters will get worse before they get better. Isn’t it time we stood together and reminded our politicians et al that our patients are people, not numbers, and that we will be looking after them long after they have moved on to some other good cause, so it’s time to start talking to, instead of dictating to, us?
    Bashed and bruised memory clinic nurse.

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  • That appointment was not wasted, as the patient does have mild non progressive memory problems, and this has now been quantified and he can live the rest of life in peace,
    The problem is the under diagnosis of dementia , 50 percent of patients with dementia have not been diagnsosed and are not benefiting from medications which when prescribed in th ealry phase could improve quality of life for many. Unfortunately this will mean lots of " perceived crappy referrals" as the diagnosis is very hard and no one has invented an easy diagnostic test. If your figures are running at 30 percent , this means the numbers are not comming through as I would be expecting 10 percent,
    What is disgraceful about this is blaming GPS for this, perhaps if charities /concerned relatives were allowed to refer directly to memory clinics in addition to Gps then perhaps this gp bashing could stop.

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  • Samuel Lewis

    all this case-finding blame-game between the Alzheimer society and the haven't-I-got-enough-to-do GPs has missed a really significant point...

    namely, that the MRC research has established that age-specific prevalence of dementia has fallen substantially in the last 10 years !

    now if only we could figure out why and how we could maybe move the argument onto QOF-based prevention ?

    Substantial decline in dementia rates...

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