Primary care is often the first point of contact for people with memory problems and suspected dementia and therefore is key to ensuring early detection and intervention as well as effective ongoing management. The South West Strategic Health Authority has a proposed ambition to increase diagnosis rates to 60% by March 2012. To support this we are delivering General Practitioner education and training programmes in assessment and diagnosis.

The priorities for January 2011 to March 2012 are:

• in order to improve information at general practice level, to publish information templates and examples of positive practice for local adaptation. This shall include the translation of standard information into languages of minority ethnic groups;
• with deaneries, General Practitioner regional leads for dementia, and Primary Care Trust dementia leads, to implement sub-regional General Practitioner training programmes in assessment and diagnosis;
• to commission and support locality-focused dementia leadership programmes to improve the commissioning and delivery of services for people with dementia and their families/carers;

Diagnosis rates
The diagnosis of a dementia, and fifteen-month reviews are captured in general practice via the Quality and Outcomes Framework (QOF). The QOF is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. The 2009/10 QOF measured achievement against 134 indicators; practices scored points on the basis of achievement against each indicator, up to a maximum of 1,000 points. www.qof.ic.nhs.uk.

The QOF data for November 2010 indicate that the mean diagnosis rate for the South West is 38%, with a range of 47%. In comparison with November 2009, the variance is 8% overall.

Screening for dementia
Screening for, and diagnosis of a dementia within primary care, is often informed by the use of the Mini Mental State Examination (MMSE) www.minimental.com. The results require clinical judgement, as MMSE is dependent on previous academic achievement. Commissioners should consider encouraging General Practitioners to make referrals for people who have an MMSE score of 25 or under to achieve earlier diagnosis of dementia.

Referral to a specialist Memory Assessment Service
Referral to a specialist Memory Assessment Service is usually required when:

• a more specialist assessment is indicated
• a diagnosis is in doubt
• the GP has concerns regarding worrying social factors, and/or if the patient or their carer requests it.