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GPs' ability to diagnose dementia hampered by 'complex' referral criteria, finds study

Complex referral criteria are delaying dementia diagnoses, and a primary care-led process could provide a suitable alternative, a study has found.

A paper published today in the Journal of the Royal Society of Medicine looked at seven London memory clinics, finding a large variation in referral criteria between them.

The researchers found that GPs were having to meet varying combinations of requirements for example cognitive tests, blood tests, urine tests and physical examinations.

The Imperial College London researchers, which included professor of primary care Professor Azeem Majeed, concluded that memory clinic referral criteria were often 'complex and time-consuming, contributing to long consultations and multiple visits for patients in primary care'.

They suggested that a ‘primary care-led process’ could speed up diagnosis as could allowing patients to directly access memory clinics without seeing a GP.

The report said: ‘GPs have difficulty assessing patients with memory problems in strict accordance with guidance within a 10-minute consultation; in our experience a significant proportion of available consultation time can be taken up by carrying out just one of the brief cognitive tests.'

It said that 'a primary care led process, perhaps staffed by practice nurses carrying out assessments according to protocols, may speed up diagnosis while reducing pressure on GPs and specialists’, also suggesting that it may ‘be appropriate to allow people with memory concerns direct access to memory clinics’.

The paper concluded: ‘A system that discourages or delays referral for dementia is highly counterproductive; an urgent review of this area is necessary to establish a system that effectively supports patients and clinicians in early diagnosis, treatment and prevention.’

Readers' comments (4)

  • What a good idea. However, I suspect that a complicated referral process is the way that specialist services restrict their availability in order to keep their workload manageable. Applies to CAMHS, Adullt Mental Health, Learning Disability, Dieticians etc.

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  • Seems to me that much of what the memory clinic does could easily be done in primary care if funded.

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  • Azeem Majeed

    The link to the full paper is:

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  • It is rumoured that psychogeriatricians have to complete the advanced level of the Work Avoidance Training Course prior to being appointed. A new consultant in our patch clearly obtained a merit pass!

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