Collaborative Primary and Secondary Care Management of Cognitive Impairment and Dementia

This is a collaborative project between primary and secondary care which will establish the role of primary care in the diagnosis and management of dementia. The drivers of the project are:

  • The need to improve  diagnostic rates: the Prime Minister’s Challenge on Dementia requires CCGs to have a quantified ambition for diagnosis rates
  • The current pathway relies entirely on diagnosis within secondary care setting. There is an ambition to bring diagnostic capability closer to the patient and into primary care
  • There is a need to increase capacity and reduce waiting times for first time assessments in some localities.

The project involves a collaborative model which increases the skill of GPs in diagnosing  cases of dementia, thereby creating extra capacity at primary care level.  This will release the secondary care capacity for the more complex diagnoses and follow-up thereby maximising the benefit of this specialist service.  A jointly agreed protocol will be developed between primary and secondary care outlining the criteria for :-

  • the diagnosis of appropriate cases in primary care
  • identifying cases appropriate for referral to secondary care.

Because diagnosis should be a gateway to support services, it also requires the identification of equivalent support services in primary care to those available in secondary care memory clinics.

Expected Outcomes:

  • A primary and secondary care jointly agreed protocol (and algorithm) as above.
  • Increased rate of timely diagnosis and with corresponding support plans.
  • Those people deemed appropriate for primary care diagnosis will receive the same quality of diagnosis and follow up in their familiar primary care setting as they would in secondary care.
  • Increased dementia awareness and on-the-job-learning for GPs and their staff.
  • New capacity for dementia diagnosis in Primary Care.
  • Maximisation of secondary care capacity for cases of appropriate complexity or diagnostic uncertainty

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