GP practices are being offered £200 payments for each dementia patient they diagnose, and provide post-diagnostic support to, under a scheme to shift more care into the community.
The three-year local enhanced service – offered to practices by NHS Bristol CCG – also offers practices a a £500 upfront payment for signing up to the LES and a £200 ‘bonus’ payment for practices to increase their diagnosis rates by 5%, or reach a target of 65% of expected diagnoses.
NHS England chief executive Simon Stevens called recently for a ‘step change’ in diagnosis in order to meet the Government’s objective of ensuring two-thirds of people with dementia have a formal diagnosis by next year.
But GPs have found objections from patients and increased waiting times at memory clinics due to the controversial dementia case-finding DES in England.
A spokesperson for NHS Bristol CCG told Pulse the scheme was set up to support general practice taking on more dementia care from specialists, by providing extra resources for diagnosing patients with uncomplicated dementia and reviewing their care, while complex cases are still referred to memory clinic.
The spokesperson said: ‘NHS Bristol CCG introduced a three-year enhanced service for dementia in July 2013 as part of our work to shift the diagnosis of straightforward dementias from secondary care to primary care. GPs are supported by skilled memory nurses in the community, to undertake a diagnoses of dementia, but complex cases of dementia are referred into the memory clinic.
‘Primary care is supported to deliver enhanced reviews for people with dementia, over and above what is required in the QOF. Our costings are based on indicative timings for clinical time in primary care, to make a diagnosis or undertake an enhanced review.’
NHS Bristol CCG added that the enhanced service had been developed around the NICE commissioning guidance for dementia and it has now commissioned a new service provided by Devon NHS Partnership Trust and Alzheimer’s Society to further support the enhanced service delivery in the morning.
The spokesperson added: ‘From our evaluation of the enhanced service, the majority of the providers now view dementia as a long-term condition rather than a mental health condition, have a better understanding of dementia and feel patients are getting a quicker and more effective service.’
Dr Richard Vautrey, deputy chair of the GPC, told Pulse the focus of such schemes should be on providing adequate social and health care support for all patients diagnosed with dementia.
Dr Vautrey said: ‘It is important to draw a distinction between screening, for which there is little evidence, and timely diagnosis of dementia for which there is much better evidence for its value. We would support schemes that do the latter and focus on supporting practices to do this.
‘The real problems however are the long and increasing waiting times to access memory clinics and the lack of social care to support patients and carers once a diagnosis has been made. This is where CCGs should be focusing their energy.’