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GPs should be incentivised to check memory problems, says dementia czar

GP practices should get payments for checking and recording memory problems in the same way they do for measuring blood pressures, the Government’s dementia czar has proposed.

Professor Alistair Burns, NHS England’s national clinical director on dementia said this would see people with early memory problems monitored and referred for preventative interventions, as they are ‘for mildly raised blood pressure’.

Professor Burns said that, now that the Government has achieved its targets on dementia diagnosis, the focus would move away from referring people to specialist memory clinics and onto transforming GPs’ care of dementia.

This would mean getting them to manage it in the same way they do long-term conditions like diabetes.

But GP experts said that such a move would be a ‘giant step backwards’, and would involve mechanisms that are being phased out, such as the QOF and DESs.

The move comes just days after NHS England revealed the Government had decided to drop the controversial ‘dementia DES’ from the GP contract, which incentivised practices to screen at-risk groups for memory impairment and refer them for specialist assessment.

The Government has hailed such schemes – part of the Prime Minister’s challenge to drive up dementia diagnoses – a great success, after the national diagnosis rate went up from 42% to 67%, despite concerns it was damaging to GPs’ relationships with patients and may even have caused harm as a result of increased referrals of ‘false alarms’.

In a blog on the NHS England website, co-written by Dr Peter Bagshaw, a GP and dementia lead for the South West of England, Professor Burns said he now wanted to ‘stimulate discussion’ about the next challenges around dementia, in particular a need to shift management of dementia from secondary to primary care – and to incentivise memory checks and follow-up treatment.

He wrote: ‘Many people have drawn the analogy between dementia and other long-term conditions, such as diabetes, and we recall a time when diabetes was a specialised diagnosis requiring specialist management but that is clearly no longer the case.

‘One concern is how cognitive impairment can be appropriately recorded in primary care – perhaps in a similar vein to raised blood pressure. We need to incentivise good practice whereby a person who comes complaining of memory can have some investigations, perhaps some memory advice, and then reviewed in a few months. This is analogous to when someone comes with mildly raised blood pressure.

But Dr Martin Brunet, GP in Surrey and leading critic of the dementia diagnosis drive, said: ’The idea of incentivising GPs to identify cognitive impairment and monitor it in some way like monitoring blood pressure would be a giant step backwards. 

’This suggestion of a new incentive is targeted at the mild end of the spectrum – the end where the needs are least and the diagnostic uncertainty is greater so that more people without dementia will get caught up in it, and money and energy will be diverted away from the real need, which is really good support.

’It would probably involve something like QOF, or a new dementia DES, when such things are being phased out.’

The dementia diagnosis drive that went too far

dementia self referral  PPL   posed by model

dementia self referral PPL posed by model

dementia self referral PPL posed by model

Professor Alistair Burns’ comments come as GP critics continue to warn the drive to diagnose dementia may be causing harm.

A Pulse investigation revealed thousands of people with ‘every day’ memory lapses have faced anxiety and long waits to get the all-clear, after referrals into memory clinics soared – figures experts described as ’alarming’.

Figures obtained from 11 NHS trusts showed 152% increase in the number of patients wrongly labelled as potentially having dementia under the diagnosis drive, causing them unnecessary anxiety and affecting the GP-patient relationship.

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