Exclusive 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 reveals.
A snapshot poll of 501 GPs in England who are taking part in this year’s DES has found that around one in five – 21% – have seen patients protest about the process, which involves asking those considered at risk if they are concerned about their memory.
The survey also shows almost two-thirds of GPs are experiencing longer waiting times 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 2012 ‘challenge on dementia’.
Under the DES, GPs are encouraged to make opportunistic offers of dementia assessment to at-risk patients where they consider it appropriate.
If a patient has suspected dementia, GPs are mandated to refer them to specialist services, such as a memory clinic, to confirm the diagnosis, then provide treatment if necessary and give advice and support to the patient’s carer.
As part of the recently announced 2014 GP contract deal, NHS England said the DES would be changed to allow ‘greater professional judgment in which patients will be offered assessment to detect possible dementia’, while the BMA said there will be a new requirement to offer advanced care planning to patients who are diagnosed with dementia.
But many GPs currently involved in the DES and responding to Pulse’s survey said they had encountered patients upset with the scheme as it stands.
Dr Zishan Syed, a locum GP, said: ‘Patients feel it is a tickbox exercise.’
‘The main issue really seems to be centred around what the consequences of a such a diagnosis is and what is actually available to help patients. In one case, the family member was quite frustrated at the length of time taken for a family member to go to a memory clinic and the actual treatments that were given during visits there. The expectations of the treatments and the little benefit when consumed or taken were vastly different. Consequently the faith in this screening by that person for themselves and other friends and relatives was actually very low as in their view it did not help at all.’
‘I think a lot of GPs share this worry – that there seems to be a political drive to push up prevalence levels for the sake of numbers and the care of patients suffers consequently as expectations of treatments do not actually match the results of the treatments that are currently available.’
Other GPs who responded to the survey said they had also dealt with complaints. Dr Roger Neal, a GP in Toddington, Bedfordshire, said: ‘Patients resent being asked’. Dr Ian Ewart, a GP in Guildford, Surrey, said patients were ‘generally unhappy to be asked, if they have no problems’.
Dr Frances McWilliam, a GP in Settle, Yorkshire, said the whole exercise appeared to be of little benefit: ‘This DES seems 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 to them?’
The survey also identified fears over increased waiting times.
Some 17% of the 498 GPs who answered that question said waiting times at memory clinics had become ‘much longer’ since the introductionn of the DES, while a further 41% said they had become ‘longer’. Around a third – 38% – said they had stayed the same.
Dr Alan Sykes, a GP in Beverley in east Yorkshire, said: ‘Why screen for more cases when there is nowhere to assess and treat them? Total madness.’
Dr Rachael Kenyon, a GP in Penzance, Cornwall, said: ‘The wait was very long prior to the DES. Now it’s ridiculous.’ 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 said.
Commenting on the Pulse survey findings, Dr Ian Greaves, a GP in Stafford who has pioneered an anticipatory care scheme for dementia patients, said: ‘The DES is a bit of a sledgehammer to crack a nut. Unless you have post-diagnostic support in place it’s a bit of a blunt tool.’
‘At the moment, it’s just a Government policy which doesn’t make much sense without doctors getting behind it and making it work in the way they support patients after diagnosis.’
He added: ‘Some people don’t like being asked, so you do have to be sensitive, even kind, and pick your moment when asking patients questions – not just be doing it in order to meet targets.’
NHS England was approached for comment but did not respond ahead of publication.
Survey results in full
Have you had any patients complain about being screened for dementia as part of the DES?
Total answered – 585
Do not take part in the DES – 84
Yes – 107 (21% of those who take part in the DES)
No – 394 (79% of those who take part in the DES)
Since the dementia case-finding DES came into effect in England in April, have waiting times at your local memory clinic become:
Total answered – 498
Much longer – 83 (17%)
Longer – 205 (41%)
About the same – 192 (38%)
Shorter – 13 (3%)
Much shorter – 4 (1%)
About the survey
Pulse launched this survey of readers on 15 October, collating responses using the SurveyMonkey tool. The 26 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung Tab 2 tablet as an incentive to complete the survey.
As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. GPs were also asked on a voluntary basis to provide their GMC number and 567 of the 673 GP respondents who answered either question did so, although these were not verified or used to screen out respondents.