The Government has said it will phase in the implementation of the dementia DES over two years to concentrate solely on patients in at-risk groups, but has rejected GPC concern it will result in undue anxiety among patients.
The Department of Health’s response to the GP contract consultation said it agreed with the NHS Commissioning Board’s wish that the specification for 2013/14 be based on clinical risk groups. These include patients aged 40 years and over with Down’s syndrome, patients aged 50 years and over with learning disabilities, as well as patients with long term neurological conditions that have a known neurodegenerative element, such as Parkinson’s disease.
However, it will continue implementing the controversial DES in full from 2014/15, which will see GPs assessing all patients over the age of 75.
The news comes after a group of influential GPs including LMC leaders and former RCGP president Dr Iona Heath met with the DHs dementia tsar to suggest alternatives, having campaigned against the DES as they said it will cause unnecessary concern for patients and overload memory clinics.
The GPC has warned of major workload implications for GPs with the DES such as filling out a questionnaire with a patient with learning disabilities, which would take 30 minutes in some cases. Dementia services are already overburdened, the GPC added, and screening could increase ‘false-negatives’ leading to undue anxiety and that screening is not supported by evidence or NICE clinical guidance.
But the Government rejected the idea that the DES involved ‘screening’, saying it is only asking GPs to screen groups with an increased risk of developing dementia rather than the whole population.
The response said: ‘The anticipated arrangements for case finding for symptomatic condition such as dementia in at risk patients is very different from screening for symptom-less conditions (such as breast cancer or bowel cancer, for example). The Department does not therefore regard the proposals as constituting screening.’
It added: ‘The (legal) direction on the NHS CB will ensure general practice has a key role to play in supporting these improvements including making significant improvements to the current dementia diagnosis rate of just 45%.’
Answering concerns from the Family Doctors Association that dementia diagnosis carries stigma, the Government admitted these issues required a ‘system wide improvement’ but said that improving diagnosis was a priority for the NHS as a whole.
The DH also hit back at the GPC’s alternative proposals for a dementia enhanced service, which included a publicity campaign to raise awareness to the symptoms of dementia and reducing waiting times for appointments at memory clinics, saying that these proposals ‘would not support improvements in diagnosis’.
The Government said the GPC’s proposals set out ‘what GP practices are largely already doing to support those with a dementia diagnosis’, and duplicated actions such as keeping a dementia register, which is already paid for through QOF.