08 • Careers


ME NOT FORGET


Primary care is expected to play a leading role in the growing burden of future dementia care. Could a GP with a special interest in dementia be the role for you?


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T IS estimated that by the year 2025 there will be over one million people living with dementia in the UK and looking forward to 2050 that number will likely exceed two million. Combine this prospect with other factors such as multi-morbidity and polypharmacy and it becomes obvious that the NHS faces significant ongoing challenges in looking after a rapidly ageing population – much of that burden falling on primary care. Last year the government launched the Prime Minister’s challenge on dementia 2020 which called for GPs to play a “leading role in ensuring coordination and continuity of care for people with dementia”. The Royal College of General Practitioners has also made dementia a clinical priority with an ongoing programme of work aimed at improving the knowledge about, recognition and management of, and commissioning for dementia. Part of that work has been to develop a


framework of guidance and competencies for the provision of service using general practitioners with a special interest (GPwSI) in dementia. It’s a role that – among others – will become increasingly important with the burgeoning demands on primary care from a growing elderly population.


What is dementia? Dementia is not a single condition but a set of symptoms that include loss of concentration and memory problems, mood and behaviour changes and problems with communicating and reasoning. It occurs when the brain is


damaged by diseases such as Alzheimer’s, stroke or other neurological conditions such as Parkinson’s disease. Around 60-80 per cent of people with dementia have Alzheimer’s disease and around 10-20 per cent suffer from vascular dementia, and many have a mixture of the two. Dementia is incurable and progressive and


often compounded by a range of co- morbidities. A survey by the Alzheimer’s Society found that 72 per cent of sufferers were living with another medical condition such as arthritis, hearing problems, heart disease or a physical disability. Early diagnosis of dementia can allow for


timely treatment, care, and support (social, emotional/psychological and pharmacological) to enable patients to better manage the condition and its impact. Certainly much can be done to help prevent and ameliorate symptoms such as agitation, confusion and depression. And this is where specialist expertise is important. A GPwSI in dementia would normally be


employed by a local health authority or clinical commissioning group (CCG) based upon the needs of the local populace and as part of a tiered, integrated service delivery. This might involve working within a local “memory service” engaged in diagnosing dementia, or undertaking an enhanced role within care homes. A GPwSI might also provide post- diagnosis support, working with a community mental health team to help dementia sufferers remain at home. A GPwSI in dementia is also likely to be


involved in providing education and support to


primary care organisations, constituent practices and other primary care providers to raise the general standard and consistency of care for people with dementia.


Required skills The RCGP guidance framework sets out a list of core enhanced skills required by a GPwSI in dementia including: • communication with the patients and their family carers


• recognition and management of physical illness, co-existing morbidities and functional/sensory impairments in people with dementia


• assessment and management of behavioural and psychological symptoms of dementia (BPSD), including appropriate use of antipsychotics


• management of drug therapy in dementia patients


• medico-legal issues in dementia care including determining capacity


• carer support


• early intervention/raising awareness of dementia


• community support/post diagnosis care of people with dementia.


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