Inappropriate GP dementia referrals double since introduction of case-finding DES
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, experts have warned
Neurologists in Sheffield have warned of potentially ‘devasting’ consequences for patients as over half (52%) of patients referred to them for confirmation of a diagnosis of dementia after the introduction of the case-finding DES in the 2012/13 GP contract had psychiatric or functional memory problems, but not dementia.
This compared with a rate of 25-30% previously.
The warning comes as the Government announced plans to step up the Prime Minister’s Challenge on dementia, including a new six-week waiting time standard for patients referred by their GP to a memory clinic.
But the Sheffield neurologists warned that the PM’s project was picking up lots of patients without dementia, despite recent data showing a 10% jump in the number of people placed on the dementia register following a scheme to pay practices £55 per additional dementia diagnosis since last autumn.
The team of neurology consultants from Sheffield Teaching Hospital and the University of Sheffield looked at 150 referrals and showed that this boost in diagnosis rates may have come at a cost.
Writing in a letter published in the journal Age and Ageing, they said that the Government ‘may not achieve its targets in reducing the dementia gap, will increase the strain on GPs and memory clinics [and] may adversely affect waiting times and the provision of good-quality post-diagnosis care and support for people with dementia and their families’.
It added: ‘Not only are we concerned about not reducing the [dementia] gap, but the incentivisation of diagnoses of dementia has the potential to make things worse… [I]ncreased referrals of people with cognitive complaints not due to neurodegenerative dementia… creates a risk of false-positive diagnosis, which can have a devastating consequence.’
Dr Daniel Blackburn, one of the neurologists, told Pulse GPs had been put in ‘a difficult situation’. He said: ‘We already know there are long waiting lists to be seen and if you send more people who don’t have dementia into those clinics… it slows down the process. But also I think there is a risk that if we don’t analyse patients carefully enough then we are going to give people a false diagnosis.’
He said he and his team would ‘urge GPs to think carefully about any history of mental problems’ when making their initial assessment but he added: ‘[GPs] are in a difficult situation. It is a hard diagnosis and because of time constraints they can only do a small amount of screening tests that don’t work terribly well.’
The consultants noted that their findings backed Liverpool neurologists, who last year reported most of the large increase in referrals to their memory clinic were for individuals with subjective memory impairment, frequently among ‘the worried well’.
It comes as Government’s 2020 aspirations for its dementia strategy included ‘people with dementia having equal access to diagnosis as for other conditions, with an expectation that the national average for an initial assessment should be six weeks following a referral from a GP (where clinically appropriate), and that no one should be waiting several months for an initial assessment of dementia’; and ‘for GPs to take a leading role in ensuring coordination and continuity of care for people with dementia, as part of the existing commitment that from 1 April 2015 everyone will have access to a named GP with overall responsibility and oversight for their care’.
The dementia DES, which is still running and pays practices for screening ‘high risk’ groups for memory problems, was opposed by some GPs on its rollout including running a campaign calling for its boycott.