Commissioners investigate variations in dementia diagnosis

The gap in diagnosis rates between the highest ranked clinical commissioning groups and the lowest has narrowed by 1 per cent over the past year. However, significant in year variation exists for individual CCGs, with rates rising by as much as 8 per cent in some areas and falling by as much as 13 per cent in others.

However, Richard Vautrey, chair of the British Medical Association’s GP committee, questioned whether targets like the national dementia indicator were a “simplistic approach” that “can lead to overmedicalisation and potentially adverse outcomes as a result”.

He said GPs would be doing their best for their patients, despite “a variation in coding”. Dr Vautrey suggested some areas’ long waiting times for care services and memory clinics created “a lack of support for patients and their carers”.

The rates represent the difference between the number of people diagnosed with dementia within a CCG area and the estimate of how many people in that area have dementia. The target rate is over 66 per cent.

On average, doctors in England are meeting the national diagnosis target, with nearly 68 per cent of patients diagnosed. But there is a gap of 39 per cent between different parts of the country.

Kernow CCG, which covers Cornwall and the Isles of Scilly, diagnosed a little over half its estimated dementia caseload in October. Islington and Camden CCGs both diagnosed over 90 per cent.

NHS England dementia target guidance advises the variation in rates between CCGs does not mean one area is better or worse than another. However, it can be an indication that further investigation is needed.

Paul Cook, a GP in Cornwall and mental health lead at Kernow CCG, alongside his colleagues, has been examining the reasons behind the group’s low diagnosis rate. They have not found a precise reason why the CCG struggles to meet the national target. The “simplest answer is it’s complex,” he told HSJ.

Kernow has worked closely with its GPs over the past year. NHS England has also looked at the region and a team spent two days with the CCG leadership earlier this year. Neither the CCG nor the team from the centre found the root of the issue.

The CCG has gone through GP practice records, comparing those with the highest and lowest diagnosis rates. 

“From that already we’re starting to see that there is a miscoding issue,” Dr Cook said.

The work has started to correct miscodes, which will have an impact on the CCG’s diagnosis rate soon. But this alone will not solve Kernow’s low diagnosis rate, Dr Cook said.

Hartlepool and Stockton-on-Tees, and Leicester City CCGs both had among the highest diagnosis rates in England last month. Both said they managed this after investing in community services for dementia patients and their families, as well as training for primary and community care providers.

Historically, GPs felt little positive benefit to diagnosing if there were no services to diagnose into, according to an academic at the University of Nottingham.

Neil Chadborn is leading a research project investigating ways to improve care for dementia patients by improving the referral process between GPs and secondary care.

He said it is still not always clear what happens to patients after diagnosis. His work has focused on people of South Asian origin for whom non-attendance at treatment services is more of a problem than white British patients.

“We don’t know if its GPs not referring someone or referring them and not following that up,” Dr Chadborn said. “Or whether it’s the clinic not being accessible – they’re generally in the community venues but is there some reason why people don’t walk through the door or make it into the clinic?”