Analysis: GPs caught in crossfire over dementia screening
The controversial dementia case-finding DES is meeting opposition from patients and driving up waiting times in memory clinics, finds Alisdair Stirling
GPs across England are facing complaints or objections from patients who ‘resent being asked’ about symptoms of dementia as part of the controversial case-finding DES, a Pulse survey has revealed.
A poll of 501 GPs in England who are taking part in this year’s DES found one in five – 21% – have had patients object to the process, which involves asking those considered at risk if they are concerned about their memory.
The survey also showed well over half of of GPs are waiting longer to get their patients appointments at memory clinics since the introduction of the DES.
The DES, which aims to facilitate timely diagnosis and support for people with dementia, was introduced in April as part of Prime Minister David Cameron’s ‘challenge on dementia’. GPs are encouraged to make opportunistic offers of dementia assessment to at-risk patients where they consider it appropriate.
But many GPs opposed the introduction of the DES, warning at the time it could cause undue anxiety in patients and that support services would be stretched.
As part of the 2014 GP contract deal, NHS England said the DES will be changed to allow ‘greater professional judgment in which patients will be offered assessment’, while the BMA said there will be a new requirement to offer advanced care planning to patients diagnosed with dementia.
But many GPs working to the current DES are reporting that patients are upset with the scheme as it stands. Dr Roger Neal, a GP in Toddington, Bedfordshire, said patients ‘resent being asked’ about their memory, while Dr Ian Ewart, a GP in Guildford, said patients are ‘generally unhappy’ to be screened.
Dr Frances McWilliam, a GP in Settle, North Yorkshire, said the whole exercise is ‘a particularly odd use of resources’. ‘Where is the evidence for hordes of patients with undiagnosed significant dementia that need screening for it and in whom diagnosing it early will make any difference?’ she asked.
Dr Zishan Syed, a locum GP, said: ‘Patients feel it is a tick-box exercise.
‘The main issue seems to be what the consequence of a such a diagnosis is and what is actually available to help patients. In one case, the family member was frustrated at the length of time taken for a relative to go to a memory clinic, and at the actual treatments that were given. The expectations of the treatments and the little benefit when taken were vastly different. Consequently, the faith in this screening by that person for themselves and other friends and relatives was actually very low.’
A total of 58% of GPs polled said waiting times at memory clinics had become ‘longer’ or ‘much longer’ since the introduction of the DES.
Dr Ian King, a GP in Redhill, Surrey, said the waiting time in his area was typically around eight weeks. ‘That is about double last year,’ he added.
Dr Rachael Kenyon, a GP in Penzance, Cornwall, said: ‘The wait was very long prior to the DES. Now it’s ridiculous.’
Professor Alistair Burns, clinical director for dementia in England, said: ‘We are looking at a number of ways in which a conversation about memory could be initiated.
‘We know there is a stigma and great public fear about dementia and we are looking at ways to make a discussion about memory as normal as a discussion about chest pain or blood in your urine.’
Which patients should be screened?
GPs should make an opportunistic offer of assessment for dementia to at-risk patients: aged 60 and over with CVD, stroke, peripheral vascular disease or diabetes; patients aged 40 and over with Down’s syndrome; aged 50 and over with learning disabilities; and with long-term neurological conditions with a known neurodegenerative element.
The assessment for dementia – GPCog or similar – offered to at-risk patients should be undertaken only after establishing patient consent.