‘Do you have any concerns about your memory?’
‘If I say yes, will that sort out your Christmas cashflow?,’ my patient replies, before giving me a knowing half-smile.
I’m relieved that Simon Stevens has stated that there are no plans to extend the dementia DES. I suspect that I’m not the only GP who has avoided opportunistically asking about memory after spotting the headline of the newspaper sitting on the patient’s lap.
The relationship that I have with my patients is crucial. It’s vital that my patients know that I will always aim to act in their best interests because, as corny as it sounds, I care.
I want them to get timely diagnoses; I want them to access the care they need at the right time. Importantly, I want my patients to trust that this will always be the case. The DES payment system undermines this.
However, GPs should ensure that dementia is recognised and patients and carers can access the care and support they need. We need to strive to slow progression of cognitive impairment and aim to maintain our patients’ good health, wellbeing and independence. To accomplish this, there needs to be identification of all the factors that potentially prevent this. We need to understand why each factor exists and implement means to overcome them. An increased dementia diagnosis target does not achieve this.
A diagnosis doesn’t automatically send health and social care services running in. Many of our health and social care services are buckling under the pressure of looking after those patients already in their care. Without increased investment, we risk diagnosing many people with dementia with the sole consequence of applying a label.
Furthermore, dementia is a complex syndrome without a diagnostic test. It is the most feared illness in people over the age of 55 and patient anxiety can increase the score on the objective tests that we do use. In the quest to drive up the diagnosis rates, we risk causing harm through misdiagnosing those with mild or subjective cognitive impairment.
I ponder the gentleman’s question of whether £55 will sort my Christmas family cash flow. I wish! Admittedly, my patient hasn’t seen the reams of paper required to write the Christmas shopping list, nor the plethora of toys that Father Christmas is storing in our loft.
However, maybe there’s now a clinical need to pursue a memory assessment – beginning with ‘Please can you tell me the year?’
Dr Lisa Harrod-Rothwell is a GP in Essex and former chair of a local CCG.
