This document discusses whether dementia should be diagnosed and treated in primary care or secondary care. It notes that general practices currently manage 90% of patient contacts within primary care. Making a dementia diagnosis requires training, confidence, time and access to diagnostics that GPs may lack. While medical treatment can begin in secondary care, ongoing monitoring and management takes place in primary care. There are concerns about workload in general practices and whether resources would need to transfer for diagnosis to occur in primary care instead of secondary care.

1. Should Dementia be Diagnosed
and Treated in Primary or
Secondary Care?
Dr Patricia Donald
GP in NW Edinburgh

2. 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.

3.  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
Pharmacy
Community
Mental
Health
Out of
Hours
Services
Dentists
Third Sector
Social Care

4. “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
1
2
3
4

5. 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?

6. 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

7. “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!

8. “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

9. Aim: to lead as normal a life as possible in their own home.
Beware of ‘medicalisation’ of dementia care!

10. GP Practice ongoing role
Medication monitoring
Physical and Mental health reviews
Maintain accurate and up to date patient record for
continuity of care
KIS for shared information
Links with Post Diagnostic support
Signposting to community assets
Signposting to 8 Pillar support

11. 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