Should Dementia be Diagnosed and Treated in

Primary or Secondary Care?

Dr Patricia DonaldGP in NW Edinburgh

General Practice

GP Practice: •GPs•Practice Manager•Practice Nurse Team•Receptionists•Secretaries

Lothian Audit 2011 confirmed that 90% of patient contacts with general practice were managed within Primary care and not referred to Secondary Care.

Multidisciplinary health care taking place outside Secondary/Tertiary Care providing care for the individual in the community

PRIMARY

CARE

GP Practices

Community nursing

Allied Health

Professionals

Optometrists

Community

PharmacyCommunity Mental

Health

Out of Hours

Services

Dentists

Third Sector

Social Care

“Diagnosis of Dementia”

Early awareness by many……..Individual, Partner, Family, Friends, Carer, Community, Pharmacist, Receptionist

Initial discussion with GP

Further assessment of memory and physical health

Referral to Secondary care if appropriate

12

34

GP making the diagnosis

• Lack of competence: requires training

• Lack of confidence• Lack of time• Lack of access to diagnostics• Lack of Post Diagnostic

support• Requires transfer of

resources with this transfer of work

• Why is this question being asked? Who will benefit?

Workload in General Practice

• GP Workforce crisis:• one third of practices in Lothian are closed

or have restricted lists • 21 GP Partner vacancies in Edinburgh

• End of QOF• New GP Contract 2017• Integrated Joint Boards• Funding allocation

“Treatment of Dementia”

• Medical treatment for Dementia started in Secondary Care and continued in Primary Care

• Other medication for mental or physical co-morbidities

• Ongoing monitoring • Stopping some medication is important

too!

“Treatment versus Management”

Treatment• Medical treatment for

Dementia started in Secondary Care and continued in Primary Care

• Other medication for mental or physical co-morbidities

• Ongoing monitoring • Stopping some

medication is important too!

Management Person Centered Care Encourage Self

management Community support Carer support

Aim: to lead as normal a life as possible in their own home.

Beware of ‘medicalisation’ of dementia care!

GP Practice ongoing roleMedication monitoringPhysical and Mental health reviewsMaintain accurate and up to date patient

record for continuity of careKIS for shared informationLinks with Post Diagnostic supportSignposting to community assetsSignposting to 8 Pillar support

Other issues to address

• Waiting Times for Secondary Care Diagnosis• Communication between Secondary and Primary

Care• Post Diagnostic Support Capacity• Shared information• Old age Psychiatry/CPNs capacity and in-patient

beds• Integration of Care of the Elderly with Psychiatry• Transferring diagnosis from Secondary to Primary

Care provides no benefit to the patient and would result in patchy and insufficient provision of services