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Dementia DES revamped to make screening offer more flexible

GPs will be given more leeway to use their clinical judgement in deciding when to offer dementia assessments under a revamp of the specifications for the controversial dementia case finding DES.

Under the agreed changes, GPs will still be required to offer the assessments to the same ‘at-risk’ groups of patients on their list, but only if the GP feels it is ‘clinically appropriate’ and ‘clinical evidence supports it’.

The revised specification comes after a Pulse investigation revealed many GPs had received complaints from patients who objected to being asked about symptoms of dementia.

They state that practices should ‘make an opportunistic offer of assessment for dementia to “at-risk” patients on the practices registered list, where the attending practitioner considers it clinically appropriate to make such an offer’.

At-risk groups again include patients aged 60 and over with vascular disease or diabetes, those over 40 with Down’s syndrome, other patients over 50 with learning disabilities and patients with neurodegenerative disease.

Practices should also still offer opportunistic assessments to other patients but only ‘for whom the attending practitioner considers a need for such investigations’.

The changed specification also details a more comprehensive advanced care plan for those people who are diagnosed with dementia, which should be shared with the patient and their carer.

Despite the changes, GP critics continue to raise concerns about pressure from NHS England to raise diagnosis rates, which they say risks causing ‘overdiagnosis’ of the condition.

Writing in the BMJ today, Surrey GP Dr Martin Brunet – a Pulse blogger – reveals that at least one CCG has made increasing dementia diagnosis rates one of its targets for the quality premium system, despite ongoing doubts about the true levels of under-diagnosis.

Recent data has suggested the true prevalence of dementia – and hence the degree to which it is under-reported – is much lower than previously thought and Dr Brunet says, according to NHS England’s dementia prevalence calculator, his own practice has a diagnosis rate of 126.7%, ‘which can only be explained by overdiagnosis, highly erroneous figures, or both’.