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Dementia DES had little impact on number of patients diagnosed

The Government’s dementia ‘case-finding’ DES has had little impact on the overall trend in increasing diagnosis of the condition compared with recent years, provisional QOF data published today suggest.

The data – released today by the Health and Social Care Information Centre (HSCIC) – show that the overall number of patients diagnosed with the condition in England went up from 319,000 in 2012/13 to 344,000 in 2013/14.

However, this reflects a continuation of the ongoing steady rise in diagnoses over the previous eight years since in 2006/07 when the QOF data were first collected – with very little change in 2013/14 after the DES was introduced.

GP leaders said that the DES was ‘not necessary’, following concerns raised by GPs that it would overwhelm care support services.

The GP strongly opposed the DES during negotiations for the 2013/14 GP contract and a group of leading GPs and academics launched a campaign to prevent it going through, because of concerns it downgraded GPs’ professional judgement and could lead to ‘over-diagnosis’ and overwhelm memory clinic and carer support services.

A Pulse investigation last year revealed that GPs taking part in the DES had been hit by widespread complaints from patients who were unhappy about being screened for dementia, while the increase in referrals was leading to longer waiting times for patients to be seen at memory clinics.

The latest figures from HSCIC show that, as a proportion of all registered patients, recorded dementia diagnoses went up 0.04 percentage points between 2012/13 and 2013/14, the same percentage increase seen from 2011/12 to 2010/11.

The HSCIC report said the data showed ‘the increase in recorded diagnosis has been steady since this data was first collected’.

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It said the long-term rise ‘may be due to the ageing population, an increase in the number of people being diagnosed, improved recording of diagnoses or a combination of factors’.

But the GPC said the data showed GPs had already been identifying the condition appropriately prior to the introduction of the dementia case-finding DES – in which GPs are required to screen at-risk groups of patients for memory problems as part of a Government drive to increase diagnosis rates.

GPC negotiators said they would continue to pressure NHS Employers and NHS England to get the DES dropped.

The Government imposed the DES in April 2013, and – despite ongoing concerns from GPs about potential misdiagnoses and challenges from academics as to the degree to which the condition is currently ‘under-diagnosed’– it was renewed this year, albeit with a change to the wording to allow GPs more room to use their clinical judgement.

Dr Richard Vautrey, deputy chair of the GPC, said the latest data support the GPC’s view that the enhanced service ‘was not necessary’ and said negotiators would continue to oppose it in this year’s negotiations.

Dr Vautrey said: ‘This was one of the imposed enhanced services. We didn’t think it was necessary, practices and practitioners were identifying and diagnosing dementia in line with clinical presentation and there wasn’t the need for this enhanced service – and that would continue to be our position.

He added: ‘The real problem wasn’t the identification of dementia it was providing the necessary services to people with dementia and their carers, and that remains the issue.

‘[It] is one of those areas we would want to look at again, as part of the discussions we will having with NHS Employers and NHS England over the coming months.’

Professor Alistair Burns, National Clinical Director for Dementia for NHS England, said: ‘I am very pleased that the diagnosis rate is increasing as it means more people with dementia and their carers are getting the right diagnosis, and importantly, post diagnostic support. The enhanced service for dementia is one of a number of initiatives to increase the rate of diagnosis and provide post diagnostic support. NHS England has an ambition of diagnosing and providing high quality support to two thirds of those people estimated to have dementia by 2015.’



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