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New Dementia Identification Scheme – Enhanced Service - FAQ

Date sent: Thursday 6 November 2014

Email sent by Wessex LMCs, on Thursday, 6 Nov 2014

New Dementia Identification Scheme – Enhanced Service - FAQ

NHS England has announced a new dementia identification scheme enhanced service that will run from 1 October 2014 to 31 March 2015.

Why?

Around 800,000 people in England are estimated to have dementia, many are undiagnosed. More than one quarter of all hospital inpatients have dementia. Timely identification and improved management can help people plan their lives better, get appropriate support, avoid admissions and benefit from treatment as appropriate. So, the case for identifying earlier is strong.

What do we have to do?

Practices will be expected to:

What will we be paid?

Practices will need to sign up to the enhanced service and provide an achievement plan to their area team by 17 November.

Practices will be paid £55 per additional patient added to the dementia register, based on figures calculated on 30 September 2014 and 31 March 2015.

How does this relate to the other Dementia Enhanced Service?

They are designed to support each other. The Facilitating timely diagnosis and support for people with dementia scheme should be familiar now. The specification makes it clear that there is some overlap and duplication of work is not expected.

The new Enhanced service adds patients who are over 60 and thought to be “high risk” of cardiovascular disease, for instance because of smoking, alcohol consumption or obesity. It also includes patients over 60 with COPD.

What are the problems with the scheme?

Firstly, as ever, practices should read the specifications carefully and try to estimate what work is needed to be done and the costs of this. The average practice may have only half the number of patients with dementia formally coded as such. However if you have already put a lot of effort into this disease area then you may have a higher prevalence and therefore less to gain through this enhanced service.

Interestingly, the specifications make it clear that the diagnosis can be made without referral to a secondary care service. This goes against recent guidance suggesting that dementia is a specialised diagnosis and should be made by a memory clinic service. This simply reflects the poor provision of specialist services and long waiting times in some areas. Some CCGs have commissioned GP led clinics under a LES scheme for the diagnosis of dementia and the prescription of anti-dementia medication.

The payment mechanism is a problem as it relies on a headcount at the start of the scheme and this is then repeated at the end of the scheme. Payment is simply based on any increase in the numbers. If a patient leaves your list or dies in the six month period then you lose the payment, despite the work you may have done in setting up your internal system.

Does the LMC recommend it to practices?

We strongly encourage practices to try to identify all patients with dementia and offer proactive care, advanced planning, appropriate treatment if required, support for carers and joint working with health and social care colleagues.

This scheme has attracted media attention mainly around the bluntness of the payment mechanism. We do not believe the scheme should have been set up this way.

Our advice is to look at the specifications, estimate the amount of work involved and the number of people with dementia that you might identify on your list. In addition to the “at risk” groups, it is worth reviewing the notes of all patients in nursing homes and identifying those patients currently seen in Memory Clinics as some may have long standing dementia but have not been formally coded as such. NHS South of England have developed some protocols for this which CCGs should be circulating to you.

Remember that if you make a new diagnosis then this will trigger QOF blood tests. If you find patients with longstanding dementia that have not been diagnosed or coded formally then ensure the date of diagnosis reflects that actual date when the diagnosis could or should have been made. This will avoid triggering the need for the QOF blood tests but those patients will need a face to face review this year (DEM002).

Useful links

NHS England Dementia Toolkit

http://www.england.nhs.uk/2014/09/10/dementia-toolkit/

Dementia Conference run by Wessex LMCs with links to presentations

https://www.wessexlmcs.com/dementiaachallengeforgpsnurseswhatarethesolutions

 

Gareth

 

Dr Gareth Bryant | Medical Director

Wessex Local Medical Committees Ltd

Phone| 023 8025 3874   Fax| 023 8027 6414   Mob| 07825173331   Email| gareth.bryant@wessexlmcs.org.uk

Address | Churchill House, 122-124 Hursley Road, Chandler's Ford, Eastleigh, SO53 1JB

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Updated on 06 November 2014 2153 views