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GPs buried under trusts' workload dump

GPs should be sued for ‘late’ dementia diagnoses, says professor

A leading academic has called for patients to sue GPs for failing to diagnose dementia, arguing that ‘the sooner someone sues a GP… the better’.

Professor June Andrews, director of the Dementia Services Development Centre at the University of Stirling, made the comments in the Letters section of the London Review of Books, in which she said the ‘sooner someone sues a GP for failure to diagnose as early as possible, the better’.

Sha also dismissed GP critics’ concerns about the £55 ‘cash for diagnosis’ scheme introduced by NHS England last October in a bid to boost dementia diagnosis rates.

Professor Andrews was responding to an article from GP Dr Gavin Francis, in which he explains his motivations for signing an open letter that called for the £55 per diagnosis scheme to be withdrawn.

In her response, Professor Andrews wrote: ‘Gavin Francis supports GPs who don’t diagnose dementia because they think there’s no point. It is outrageous that publicly funded professionals could withhold important information about my health.

‘It’s all very well being professionally insulted by the Government’s offer of £50. The sooner someone sues a GP for failure to diagnose as early as possible, the better.’

Professor Andrews said that ‘significant financial and emotional damage and unnecessary disability can be avoided’ from early diagnosis, but pointed out wild variations in diagnosis rates, from 20% in London to 75% in Belfast.

She added: ‘Francis says “presumably” the Government thought low diagnosis was evidence of poor care. If anything, it is evidence of no care at all. But that will be for the lawyers to prove.’

Professor Andrews is described on the University of Stirling website as ‘a recognised leader in the world wide movement to improve services for people with dementia and their carers’ who has won international awards and previously set up and directed the Centre for Change and Innovation in the Scottish Executive Health Department.

According to the website entry, the Dementia Services Development Centre she now directs was set up to ‘devise and implement interventions to drive change in clinician behaviour and health and social care organisations in order to achieve the ambitions of national dementia strategies in the UK and beyond’.

Readers' comments (94)

  • Suing GPs for so called 'late diagnosis' is actually pretty offensive and grossly unethical. What does this academic thing we are doing all day exactly? Clearly she has no idea of the pressures that we are under or that primary care as we know it is about to collapse.

    As for the assumption that 'significant financial and emotional damage and unnecessary disability can be avoided' there is not a shred of evidence to support this. GPs are caring for people, not diseases.
    ' the Government thought low diagnosis was evidence of poor care. If anything, it is evidence of no care at all' is also a blatant lie. We look at people holistically taking into account their overall needs. This statement is bordering on trolling, the professor would do well to reflect on this.

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  • 3 points-
    The clue is in the word academic
    Which drug company is sponsoring her then?
    I thought the latest complaint was that we were over-referring patients who had momentarily mislaid their car keys- the Lost-Car-Key Syndrome

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  • Vinci Ho

    So according to her philosophy,I suppose 2 weeks rule referral for dementia will be 'perfect' because like cancer referral , you can then name and shame GPs. Wow!

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  • Give her 50 consultations a day, under 10mins each and see how many dementia cases she misses....

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  • Hardly a 'leading academic', the university website lists seven (yes seven) publications three of which are book reviews and two are pieces in N'using Standard'.
    her bio is hardly modest, but she saves the best line to last..
    About:
    I am the Director of the Dementia Services Development Centre (DSDC) in the School of Applied Social Science at the University of Stirling. The DSDC has offices in Belfast and London in addition to the Scottish campus. I am a recognised leader in the world wide movement to improve services for people with dementia and their carers. I have been recognised with the Founders Award of the British American Project of which I am a Fellow, and was awarded the Robert Tiffany Award by the Nursing Standard for my international work. I have considerable experience in management of change in health services, having set up and directed for three years the Centre for Change and Innovation, in the Scottish Executive Health Department. The purpose of the DSDC is to devise and implement interventions to drive change in clinician behaviour and health and social care organisations in order to achieve the ambitions of national dementia strategies in the UK and beyond. In my current role I am applying those skills across sectors in the care of people with dementia, including the health, social services, private and voluntary bodies who provide care. I am a former trade union leader, NHS manager and senior civil servant.

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  • Nice from the academic bubble, all supported by staff and mice and very little real life responsibility.
    She has forgotten there is no diagnosis...I'd like you to quantity 'late' professor. I will just tell every child you could get dementia early doors and give them a leaflet.Do not hide behind your title or lose touch with reality.

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  • Professor Andrews is a nurse, she has no medical school qualifications. She has never actually made or had to make a single diagnosis herself. Enough said.

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  • This comment has been removed by the moderator

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  • So then we make an early diagnosis - and then we can cure dementia ,right ? . Er - no.

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  • why just sue - why not call for a custodial sentence - i'm sure the legal system will oblige and don't forget being struck off - again the GMC will oblige.

    the result -> defensive practice i.e. anyone with a hint of a memory problem will be referred. The fall back will be that NHSE will complain about the cost and we will be monitored on dementia referrals and it will be published by the CQC. Will we care? no - we will have left by then.

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  • If the diagnosis rate is so much higher in Ireland than London what is the cause.?higher payments? Better training? Must be a reason.did she spell it out anywhere?

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  • June Andrews

    OK, I know I take my life in my hands, but here goes. By the time you wrote this I had already spent time, as asked, in the surgery of the GP who authored the article I was commenting on, and our views are closer than you think. If you think I am wrong, unfortunately you spread my wrong view much further than it could ever have gone. But I'm sorry for tempting you to do that.
    To Sessional GP can I say, I said as soon as possible, and by that I meant to reflect that some people clearly are not doing it as soon as possible because of all the families I meet who feel that their GP is not prepared to talk about it even though they've got people with rather florid symptoms.
    And can I say to GP partner that I'm not as insulted as I could be when you say that my being described as an "academic" implies by definition I'm not allowed to have a view, or qualified to have a view. But I do realise your aim is to insult me.
    Dear Vinci Ho, thank you for giving your name. I don't think a two week rule would be right. What I think is that I've seen cases where the doctor told me the person had dementia in his/her view but they were not pursuing or giving a diagnosis because there was no value. If one of those patients lost control of their car and knocked down some people I think they'd be cross enough to sue?
    Dear Dr GP; I know you all have to work incredibly hard and under terrible pressure. So it might not be possible for you to put someone forward for diagnosis for time reasons. But I have met a number of GPs who say they won't do it because there is nothing to offer, and then it turns out they don't know about local services. The worst cases are not about time, but attitude of the doc, and I know you are not all the same.
    Dear Dr GP, I am sorry you don't think I am a leading academic. I'm sorry if I've not challenged everyone who has said that about me. And the Uni website is really poorly updated...I'll get round to that, but thanks for pointing it out.
    Dear Practice manager; I'm not in a bubble, and I think I see more families and people affected by dementia in a year than you will see in your whole life. I'm not hiding behind my title; you can have my email address if you like. I'm the one using my own name. Lets not be silly and diagnose too soon, but how can so many people die without ever being diagnosed? Surely it would've helped a bit?

    Dear anonymous GP partner; nurses do diagnose dementia. I don't mend cars myself but I'd sue a garage that caused me harm by doing it wrong. The fact that I don't do it does not ban me from having a view, surely?
    Dear GP partner; I'm sorry you object to the British American Project.
    Dear last GP partner at 4.06; You rather made my point for me, much better than I did. I know a lot of you don't diagnose it because you can't cure it, and that's unfair. Even if you can't cure me, you could give me the address of the local carers organisation or alzheimer organisation, and let me get on with helping myself, and I'd be much less trouble for you.

    I'm really sorry I made everyone so angry, but to be honest, I said it in a journal hardly anyone reads and GPs keep repeating it without ever really telling me why a person with dementia is not entitled to a diagnosis. Also the personal insults are fairly hefty. You are a highly respected profession but the way I"ve been attacked for this, about which you are so pleased, I think reflects really badly on some of your colleagues. Shutting up an academic, a nurse, or just someone with a different opinion? The main messages of support I've had are from quiet people. signed June Andrews

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  • It's Hyacinth Bucket!

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  • We don't appear to be able to diagnose dementia without a trip to the memory clinic nowadays so if there is a poor service locally then a diagnosis may be difficult to achieve. Secondly, suggesting people should be sued for not making a diagnosis is unusual and just a bit unpleasant really but I suppose is the world we are creating in this little island of ours. Last time I checked it was rather easy to reregister with a gp so if there really was a gp who was pathologically against referring people to memory clinics - odd but I suppose it's possible out of 40,000 gps there might be one or two outliers - then walk up to another gp, fill out a form and hey presto! Or as you suggest one could attend a solicitor and start legal proceedings.

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  • ah yes nothing really changes .."beware of a nurse with a course"

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  • They are not working hard enough, beat them again.

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  • bloody hell, i have not seen a single patient who benefitted from dementia specialists. not enough diagnosis clinics. looks he has develops psychotic dementia. Prof better get anti-psychotics

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  • I have no problem with considering a diagnosis of dementia and referring to my local Memory Clinic those patients (and their relatives) who have a concern about their mental function. However the drive for diagnosis must come from the sufferer and not be driven by professionals with vested interests in boosting numbers to treat. You can bet there is a powerful pharmaceutical lobby in the background. How early is early diagnosis? Frankly if I start having some mild memory dysfunction the last thing I want to hear at this early stage is that I have Alzheimer's disease which my doctors can't cure!

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  • dear author.I am a full time GP
    my mother has severe dementia . I have very autherntic first hand knowledge of this ( am not treating her in any way)
    now it is severe the one thing my father is grateful for is that the diagnosis was not given earlier as she would have been terrified. of course he had a fair idea but deliberately avoided medical situations where it could be asked. it allowed my mother to enjoy her last years of independence

    now she is severe she has all the services and reached crisis anyway and ended up in an acute hospital

    you are fooling yourself if you think dementia can be controlled with care plans and screening

    and if I or my wife had dementia. I wouldnt use the services until i had absoultely no choice

    (for GMC reference I screen for demetia and refer within guidelines)

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  • Dear professor thank you for your answer to the comments. It sounds like you have honest intentions, but I am sure you see that such comments are inflammatory and counter-productive. From a GP perspective, early diagnosis is difficult, and rarely appears to benefit the patient. Often if we refer pts with mild memory problems they are seen in memory clinics and given a diagnosis of minimal cognitive impairment and then may or may not be followed up by psychiatry. If a diagnosis of dementia is made, only those with Alzheimers receive much follow up where I work, and only because they on medication.

    I do not doubt the importance of dementia and its appropriate diagnosis. We in primary care have a vital role to play in it. However such finger wagging behaviour is singularly unhelpful, and will only put GPs' backs up.

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  • We as GPs are all a little fed up of everyone telling us how to do our jobs wheter they belong to our proffession or not.This website tends to attract folks to do this to us, unless they go to the daily wail.As this part of the proffession we have been under what seem like an organised assault for over 5 years from all angles, forgive us if we project some of that frustration and anger towards them.The anonymous crowd are fed up and pi**ed off and the grassroot GPs have no other way of voicing that other than of forums like this.Put yourself up as knowing the everday workload and issues we deal with and telling us how to do our job you should expect some of that ill feeling to surface(Looks at the comments for the politicians and some of our own bretheren).

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  • June Andrews

    Dicing with death! Here I go again.Anonymous at 4.16 That is a really good question. Why the difference?
    GP Partner 4.56 pm So now it is personal remarks about my appearance! Maybe I should list the names of all of the older women in public roles so that I can anticipate what else you might say about me. I wasn’t hired for my looks, but point taken. At least I show my funny face.
    GP Partner 5.35pm I really appreciate how frustrating it is if they require you to go to the memory clinic even for very obvious cases, but in many places a GP can diagnose with out that. I didn’t mean to be unpleasant. If I point out the difference in diagnostic rates people say the figures are garbage, and if I tell individual stories people dismiss that as anecdotal. For example, one family that lost out on tens of thousands of pounds financially because the GP did not diagnose for a long time after he was pretty sure it was a case of dementia. He said he didn’t diagnose because he thought there was nothing that could be done, and he was sorry and surprised when he heard all that could be done. He felt he could not know all of that, but all he needed to know was the phone number of a local support organisation, so the family could have helped themselves via that. In another case the man was piloting his tour boat long after the family were pretty sure this was the problem, but the GP would not discuss it with them. I know that you can change your GP, but if you’ve got dementia that might not occur to you and your family can’t change your GP without permission. A solicitor would not be interested unless a case could be made that the dementia was a bit obvious and there was a loss to someone, and that the GP had decided to over look it. But this does happen, I am afraid.
    Anonymous 5.35 I don’t understand that but you could say it again differently?
    Sessional GP 5.58 The research shows that screening is of no value, which is what I think you are suggesting.
    GP Partner; 5.59 Diagnosing people with dementia saves effort for GPs so it should relieve their burden not add to it. You can direct families to self help, or you can start to anticipate the problems for your patients who have no one, or get voluntary or others involved if you are lucky enough to have local services.
    It is not beating you up.
    Locum GP; 6.00 I don’t think I understand that.
    Going back to anonymous at 4.16…that is a really good question.

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  • Look this isn`t a game.They come with there spouse,or,other family member,or a friend or on their own. They are losing their memory. We rule out organic cause., and then review them again and again .We make sure their spouses are coping, and community support staff are there if needed. And we continue to monitor them. We send them to a memory clinic who tell us what we already know. They may need medication. We all know there is no cure. We continue to review. Eventually they may need to go in to a care home. No one wants this .Their spouse feels guilty, but they shouldn`t. We support them too. But they still feel guilty. At least they are safe, but they our still our patients, and we continue to review.
    We know what the situation is. The patients, at leastthose who have insight know what the situation.The spouses and other family members know what the situation is. We encourage them to ask us if they have questions. The care homes know what the situation is.
    Whether a box saying dementia is ticked or not doesn`t matter a jot . The main thing is that they get the care they need. If they don`t it is a resource issue and not the fault of the GP.
    Hundreds of thousands of patients have dementia. Suing the GP wont help any of them (or improve their care) !!

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  • June,

    thanks for the comments - what would you recommend as a positive way forward?

    i.e. what do you want GPs to do ?

    I ask this as practically we are under a lot of pressure time / resource wise and if you suggest we should be referring on first presentation please say so, should we be investigating on first presentation as well? how much time should we spend as 10 mins will not be enough?

    what we need is positive support to do our jobs, encouraging negativity will not help us to help patients.

    if someone like yourself concludes GPs should be properly resourced time wise and without pressure from CCGs for over-referring it will help our patients.

    the other point is we need hard evidence i.e. facts/figures re: is it specific GPs or is the problem more widespread and an understanding of what the barriers. Is it a training issue, attitudes etc. It seems to me more research is needed. Encouraging legal action will back fire and you may find GPs decide to go private and patients will lose out.

    I don't mind being a private GP and spending hours with a particular patient to take a thorough history, MMSE/GPCOG, bloods etc but will charge for it. I will have the time to do my job properly. GPs need support otherwise they will walk out - it will happen.

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  • Peter M 'they get the care they need' HAHAHAHA.....most of us would rathr be dead than go into one of these 'homes
    June - so many of the posts get insulting...even in a personal way -it's hardly shocking any more - just take the serious ones on board

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  • June Andrews

    Dear Dr Wheeler; thank you for your comments. I can understand why anyone would be worried about forces at work looking to sell medicines. But even if increased diagnosis suits the pharma lobby, I believe it suits people with dementia. To go back to the inflammatory remark about legal action. Any doc would have a great defense if they could say, “You know, I thought she might have dementia, but she, and the family would not tolerate any discussion of the possibility.” That is the opposite of doctors saying “You know, I’m pretty sure that is what she has, but the services round here are so bad I’m not going to raise the issue.”
    Doctors can’t cure Alzheimer’s, but that is no reason to deny people the signposting they need to the health and social services that are available to them. If the local services for my mum are rubbish, at least tell me what the problem is and I’ll buy something in for her?
    And the politicians do want it for political reasons. They are ashamed about the differences across the UK. That’s why the English government did the embarrassing thing with the bits of cash. But what does the difference across the UK tell us. Surely no one believes that the majority of GPs in Northern Ireland are in the pay of the drug companies? The Scottish GPs got diagnosis rates up by 30% in three years without the extra cash (But then, Nicola Sturgeon was the health minister…so what I can say! She’s popular!)

    Dear 6.20 full time GP I am so sorry about your mother and what you are going through as a family. It reminds me of when my grandfather had cancer and all the family was told not to tell him in case it depressed him. I asked him if he’d like me to find out more about what was wrong and tell him and he winked at me and said, “I know what it is but I’m not worrying your gran.” Families are so complicated, and different. I’m sorry about the path you’ve had.
    As I said above, there is no research evidence for screening, so it is not what I suggested at any point.

    Dear Dr Connolly Thank you for your reply. The dementia path you describe where you are is very similar all over the UK, and not terrific, but better than nothing, I hope.
    I take the medicine you hand me for being finger wagging, bitter though it is. But did you see what the original doctor said in his article? He implied GPs would give false positives to get their £50 from the government. If I was a GP I’d have been insulted with what he was saying. He appeared to be defending the low diagnostic rates in England. Since then I’ve spend time in his morning surgery and we talked a lot.

    Anonymous GP 6.25. I sort of laughed out of sympathy when you said you are all fed up, because even I had worked that out for myself. I wish GPs realised how respected and admired they are. When someone says something bad about GPs who do bad things, all the GPs feel the hurt. It is a very hard place to be.
    I’m fed up as well, to be honest.

    Dear Dr Maksimczk What you describe sounds like a textbook case of diagnosing and managing dementia. I don’t understand where we are disagreeing. Did you think I meant that you should get into trouble for not putting the person on the register? Not at all. I don’t care if you forgo the little bit of money you could get from QOF of if you down play the local statistics. From my point of view you managed. I don’t expect you to read all I say, but above I gave cases where the doctor chose to do none of this.

    Anonymous 6.51 Thanks for your question. I’m not suggesting premature attempts at diagnosis. I’m responding to the fact that the difference in diagnosis rates in parts of the UK is from 20% - 70% and when the English health bosses tried to tackle this they got into trouble. I’m not in their pay or the pay of the pharma companies but why were they wrong to do that?
    I’d like to know what your suggestion is for the way forward to rectify the huge variation. Maybe 70% is too high? Maybe 20% is just right. Maybe the figures are garbage. What are they doing in Northern Ireland, and maybe also in Scotland that is so radically different? Are they wrong to do that? I’m only asking. And as I said above… My concern is when GPs make the unilateral decision that because they don’t know about local services or because they think there is nothing worthwhile in the services around, that they won’t try to raise the question of dementia.
    The hard evidence is available from the health department, but many of my correspondents here and in other forums don’t believe it. I got kicked hardest from GPs in parts of the country where the diagnosis level I know is very high.
    Maybe you could start by working out where your own practice is in numerical terms?

    Anonymous 7.28 If anyone is still reading this…it is time to draw this to a close, though I am happy to be found at the University if I can offer anything else of worth. If not, thank you and goodbye for now.
    I’ve seen some nice care homes, and worked to make nasty ones better. It is part of what we do as a living at DSDC www.dementia.stir.ac.uk
    As a footnote, I’d like to say that I’d have been happy to talk to the journalist, and explain how I’d spent time with the GPs most directly involved. I was a bit cross at being reported without the chance to respond, but at least it has let me have these conversations and bring this to the attention of those who have followed.
    Signed June Andrews

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  • Took Early Retirement

    Hmmm,

    Well, I salute you for - probably a first on here- actually coming to defend what you said.

    I think the comment about suing was unhelpful, to be honest. Situations clearly vary across the country. I worked, till 11 m ago, when I took early retirement due to the general stress of work and the fact that the world and his/her dog wanted to tell me how to do my job.

    Anyway, regarding dementia, where I worked, in S Hampshire, we had a WONDERFUL psychogeriatric service founded by one of the greatest unsung heroes of the NHS- Dr Colin Godber. (Son of the Chief Medical Officer of the same name.) However, the memory service was becoming over-stretched +++.

    Just before I retired, I had decided to start my own way of dealing with the problem, but the lack of DIRECT ACCESS TO CT made things difficult. (OK, I know not everyone needed a CT but it would have been nice when one suspected a vascular dementia, a tumour (rare) or something else. (Even rarer.) )

    So, I decided I would do a MMSE (yes, I know there are more sophisticated tests but we are talking a theoretical 10 mins here.) Do the bloods, start Donepezil and refer to Memory clinic.

    However, given that I have never seen anything other than a very modest improvement with Donepezil, I too feel that an early diagnosis doesn't help much, if at all. A bit like PD really.

    I guess the REAL need for input from experts is picking out the odd atypical one who may be depressed rather than demented?

    John G BM FRCP FRCGP

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  • Yep sue GPs - make them bankrupt and you have no GP caring for thousands. Nobel Prize idea.
    She is no authority - this is one condition nature has command of...fact.

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  • No more needed...... "academic"
    No risks or responsibility
    No pressures or fears of inadequacy
    Not in her place of work 2 hours after official contracted hours .... As I am now
    I have nothing but contempt for your remarks

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  • As part of our local NHSE 'validation exercise' we have been sent a list of patients identified 'at risk' but not yet coded by us as 'dementia'. Interestingly, in the majority of cases this is because we have made a referral to the memory clinic, no firm diagnosis has yet been made, but anti-cholinesterase Rx has been initiated.

    Shall we sue the local Memory Clinic for failing to provide definite diagnostic codes?

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  • It's extremely disheartening to hear a fellow professional actually encouraging patients to sue colleagues
    It's just unacceptable.
    There is no good diagnostic test available, even someone with barn door symptoms. A diagnosis of Dementia still has stigma associated with it , lots of legal minefields etc, property welfare rights, families bickering and arguing etc etc,lasting power of attorney , corrupts solicitors, lack of carers in the community.
    Rather then blame Gps who frankly are not in a position to diagnoses dementia due to lack of good tests, perhaps patients and families should be encouraged to self refer to all those memory clinics and they can jump through the hoops to get their relative seen.

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  • Gutted !!, why ? That a nurse should turn against her colleagues in general practice. That an academic has allowed her ivory towers to encroach upon simple reasoning and observation of practice. I am ashamed of her findings and comments, as I am sure are many of my fellow practice nurses and ANPs. My apologies for this trite unsubstantiated, passed off as academic diatribe!

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  • Very unhelpful article.
    Methinks the lady doth protest too much.
    Probably regrets some/all of it.

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  • I have to admit I applaud the effort and time June has made to respond about these issues. The only other person that bothers is Una.

    it seems more research is needed to explain the variation and whether or not anything should be done about it - there are wider implications that need to be explored. I agree that not being bothered is bad practice but why are they not bothered - do they think that it will not do their patients any good - are you really sure they are just bad GPs?

    encouraging legal action will be counter productive - there is already a complaints process in place - so proper protocol should be explored first i.e. local grievance policy.


    it's like saying your not happy with your boiler I will get a lawyer to sue the fitter rather than using local complaints procedure to rectify the problem. All this will do is open the door to other groups who will say 'time to sue GP if they don't diagnose diabetes, asthma etc'. At this point all goodwill from GPs will go and even the NHS die hards will exit.

    my understanding is that lawyers want to move to more mediation and dispute resolution than ending up in court and you may run the risk of an innocent GP being sued winning and coming after you.

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  • June - you raise some valid points about resources that can be accessed by achieving a diagnosis. However, encouragement of patients to sue their GP is quite frankly bizarre and unprofessional. I would highly recommend a workshop delivered by the MPS which highlights how damaging we can be with our dialogue about our colleagues and how this can lead to complaints. If you feel passionate about something and feel GPs are not doing a good job - engage with them and educate them if that's appropriate. You certainly know how to win friends and influence people.....

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  • June Andrews makes several unsubstantiated or inflammatory statements in a letter and seems surprised that GPs react negatively to them. e.g.
    "Significant financial and emotional damage, and unnecessary disability can be avoided if you are told what’s wrong at the earliest opportunity and then take action to slow the progress of the disease."

    In the case of dementia, harm could be caused by the trauma of living with a diagnosis for longer, or by being given a putative diagnosis of dementia which turns out not to be the case. There is little that could be done to slow the disease progress.

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  • This academic makes a inflammatory comment in a mass media which could cause serious consequences, not host for the GP but patient/family who wrongly focus their energy on law suits instead of focusing on their life.

    And her answer?

    It was in a magazine no one reads so it's OK.

    I'm sorry but you seriously need to look yourself in the mirror and do something about your over inflated ego

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  • Oooh what a juicy headline this one....print it and watch the comments fly!
    Anyone ever get the feeling PULSE is a wind up arm of the Daily Mucus?

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  • can we start with an academic that has lst touch with reality?

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  • Offensive, thoughtless and ill-informed. She obviously is someone who highly values her own opinion. There is little real evidence of more than a fleeting benefit from dementia drugs which are hugely expensive. Early diagnosis mainly leaves the elderly labelled and frightened.

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  • Obviously a 'professional' who suggests recourse to legal action may not be particularly competent . I don't think she has done herself any favours despite having some bravery in coming onto the forum.

    I don't work in dementia but there has been a big drive in my area to involve patient groups and university researchers in pushing products. I like to think in my field that is for good reason because often we are not using some products which have evidence based benefits purely for short term cost reasons.

    That cannot be said for dementia, we have nothing in the pipeline, there is work on some immunotherapy approaches but active clinicians will hear about the trial evidence before I probably will.

    To ask campaign for improvement in resources and quality of care is in everyone interest. Malignant and malicious comments about the primary care profession is not helpful.

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  • Dear Prof Andrews
    I know you mean well and you are only trying to get the best for a group of people who have been historically neglected. However, it is highly inflammatory to suggest GPs should be sued for not diagnosing Dementia early enough. It fuels the current trend to blame a group of professionals, who work bloody hard to look after ALL of their patients, including those with dementia. Most GPs, including myself, take the responsibilities of job very seriously. If some of us are in no rush to formally diagnose dementia, it is because things are never black and white, and formal diagnoses often dont help situations and in some cases, can make things much worse. 25 years ago, my father was diagnosed with vascular dementia. Knowing what was coming did not help him. It made him highly anxious and depressed. He was only 55 when diagnosed and the biggest problem he and my mother had, was finding the right social support to help the both of them cope. Because he was under 60, many services then would not even consider helping him, as he was too young. Things have come on leaps and bounds since then and thankfully there is much more help out there to help people with complex health needs, both young and old. However, none of these things are dependant on official diagnoses, nor should they be.
    Please. Please dont beat and already beaten profession with threats of suing them, but use your influence to improve services and awareness of things that can help people, rather than inciding litigation on a group of people who are not deliberately withholding diagnoses from people, but who are rather trying to manage the whole person AND their whole population over a vast array of diseases. If more GPs continue to leave the profession thanks to new threats like this, what exactly do you thing dementia diagnosis and treatment will be like then?

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  • The professor nurse should be ashamed for these inflammatory comments and should be referred to the NMC for bringing the whole of the medical profession into disrepute. Can she stick to telling people who work like her how to do their job rather than people much more qualified in diagnosis and management of dementia? Shame on you. Thank you the nurse who commented about how ashamed you feel about her for your support . The "professor" needs to take a good hard look at herself in the mirror.

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  • One would expect a responsible attitude from a 'Professor' and not a whimsical 'Sue a GP...' so I am proved right.
    Probably you forgot to add that this is Cameron's agenda and it's election time. I, on the other hand, although in favour of diagnosing everything in time - not just the government lead drive for dementia, as a hardworking GP can only say you and your entourage can buzz off to Mars with your stupid bullying and pressurizing GPs.
    Have you been promised a Directorial post after elections?

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  • ''The main messages of support I've had are from quiet people. signed June Andrews.''

    I wonder what that meant.....? People who are not saying anything,,,,,mmmm, or are we talking about auditory hallucinations.

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  • It is welcome that Professor June Andrews is engaging in discussion.

    I have met Professor Andrews several times and I know that she is a passionate advocate for those living with dementia. However I do not agree with her on early diagnosis of dementia, and never have. Professor Andrews is aware of our differing views on this. I have advocated for a timely approach to diagnosis and was delighted to see this enshrined in the “Glasgow Declaration” in October 2014. This declaration has now been signed by 50 dementia organisations across Europe.

    I am afraid that the suggestion by Professor Andrews of adding in a "stick" (threat of legal action) in addition to the £55 "carrot" seems hugely misguided to me and potentially most harmful.

    I have covered this here: "Can't - Won't - No point" https://holeousia.wordpress.com/2015/04/21/cant-wont-no-point/

    I work in NHS Scotland and was concerned about the target based approach Scotland took. This approach WAS incentivised (but not at GP level) as NHS Boards were paid for reaching the target. I must correct Professor Andrews on this. The target was specific and asked for "Early diagnosis". In my experience the target skewed behaviours in unethical ways and at all levels: from senior managers and right through the clinical “chain”: as a result, my experience was that the consultation no longer seemed to belong to the patient and doctor. Rather a political target loomed over both.

    Scotland was TRIUMPHANT (!) about reaching the target and in giving evidence to Westminster parliament chose to shame the rest of the UK. This was the beginnings of maps and targets rather than patients and patient-centredness.

    As Dr Brunet has pointed out target rates are very crude and the ‘dementia prevalence-calculator’ implies scientific and epidemiological accuracy though it has (to my knowledge) never been studied in any academic detail (at least independently) before being implemented as the guide to policy in NHS England. This is an experimental approach. Delayed diagnosis of dementia is a complicated issue. Surely the better approach is to support and encourage professionalism in our profession rather than target (and I use this word correctly in this case) our GP colleagues.

    The approach that Professor Andrews forthrightly advocates risks inappropriately medicalising swathes of our elderly. Age-related cognitive changes are real (distributed on a parabolic curve) and should not be treated as dementia. The risk is that care for those living with dementia worsens as services get stretched as a result. I am sure Professor Andrews does not wish this. In my opinion, inverse care is a very real risk.
    I worry that we are adding great fear about all this through simplified "awareness" campaigns (I am of the view that the Big Dementia Charities carry much responsibility here). I feel that Prof Andrews approach, as a high-profile and international expert, also risks this.

    Lastly, whilst I very strongly disagree with Prof Andrews on this matter, I respect her as a person and do understand that she has a good heart. I just think that Professor Andrews has not thought through the complexity and the ethics of the doctor-patient relationship which is far more important than any crude target.

    Dr Peter J Gordon
    NHS Scotland

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  • Wow!
    Amazing debate

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  • Ah, nurse! Clearly lacking in insight.

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  • How can any doctor encourage a patient to sue a colleague without full knowledge of the consultation that took place?

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  • I respect Peter Gordon's defense of June Andrew's character.

    However she has crossed the line with demands for medical colleagues to be sued. I only hope the NMC are able to take some appropriate action.

    A formal written apology should be be a reasonable starting point.

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