Raising the barriers: An action plan to tackle regional variation in dementia diagnosis in England

All-Party Parliamentary Group on Dementia

A dementia diagnosis is a fundamental first stage of the dementia pathway. Missing out on an early and accurate diagnosis can have a significant negative impact, for example limiting access to symptom management interventions, ultimately leading to poorer outcomes and increased health and social care costs. At present there is a difference of over twenty percentage points in the dementia diagnosis rates between the highest and lowest performing Integrated Care Systems (ICSs) in England.

This is a report of an inquiry that examined how the most deprived and rural communities are particularly adversely affected by this regional disparity. The inquiry’s findings show a complex picture in which issues ranging from variation in population health risk and dementia public health understanding, to the geographical spread of brain scans and transport networks all play a part in regional dementia related health disparities.

The report sets out a number of recommendations across the core themes of dementia diagnosis, data, workforce and public health messaging. Collectively these recommendations outline how dementia pathways can be strengthened to enable access and quality care across all settings, communities and regions in England so that all who need it can receive a timely and accurate dementia diagnosis.

Full report: Raising the barriers: An action plan to tackle regional variation in dementia diagnosis in England

National framework and operational guidance for autism assessment services

via NHS England

This national framework sets out the principles that should underpin the planning, design and delivery of an autism assessment pathway that works for everyone irrespective of where they live, their background, age, ethnicity, sex, gender, sexuality, disability, or health conditions. Implementation of this national framework will include taking actions to reduce known sources of health inequality that exist in access to, or experiences of, an autism assessment across England.

The guidance is intended to help integrated care boards deliver improved outcomes in all-age autism assessment pathways. It includes operational guidance, intended to guide strategic decision making about the range of autism assessment service that should be provided in each area.

Full guidance: A national framework to deliver improved outcomes in all-age autism assessment pathways: guidance for integrated care boards

Cancer risk in patients with fatigue

White, B. et al | Underlying cancer risk among patients with fatigue and other vague symptoms: a population-based cohort study in primary care | British Journal of General Practice February 2023; 73 (727): e75-e87. DOI: https://doi.org/10.3399/BJGP.2022.0371

Tiredness combined with other general symptoms like weight loss or abdominal pain could be a sign of cancer in older patients, according to a new study from University College London. Researchers looked at health records of over a quarter of a million people in England whose doctors noted that they were tired, but who didn’t have any ‘alarm’ symptoms of cancer. It showed that more than 3% of older patients who were tired and had other general symptoms were later diagnosed with cancer within the next 9 months. These findings could help doctors spot cancer in people who don’t have any obvious symptoms.

Full article: Underlying cancer risk among patients with fatigue and other vague symptoms: a population-based cohort study in primary care

Diagnosing hypertension in primary care: the importance of night-time blood pressure assessment

British Journal of General Practice 2023; 73 (726): e16-e23. DOI: https://doi.org/10.3399/BJGP.2022.0160

Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does not dip, or rises (reverse dipping), have poorer cardiovascular outcomes.

This retrospective cohort study investigated the importance of measuring night-time BP when assessing individuals for hypertension. The authors conclude that not measuring night-time BP puts all groups, other than dippers, at risk of failure to identify hypertension. As a result of this study, it is recommended that GPs should offer ABPM to all patients aged over 60 years as a minimum when assessing for hypertension.

Full paper: Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment

Elective Recovery Taskforce to tackle COVID-19 backlogs

The government is setting up an Elective Recovery Taskforce to help the NHS deliver on waiting list targets, bringing together a range of healthcare experts | Department of Health and Social Care

Patients will benefit from quicker access to treatment and lifesaving diagnostic tests close to home following the launch of a new Elective Recovery Taskforce and approval of 19 new one-stop-shops for tests, checks and scans. The new diagnostic centres will be located in the heart of communities across the country including football stadiums and shopping centres offering a range of services including MRI, CT and x-rays, making tests more accessible for patients.

The taskforce will bring together a group of experts to work on a series of recommendations which will be put to the government early next year on how the NHS can better commission the independent sector to support the NHS. The taskforce will look to improve communication and collaboration between the NHS and independent sector, clearly setting out what theatres, beds and other settings (such as outpatients) are available in the independent sector.

Full detail: Government turbocharges efforts to tackle COVID-19 backlogs

NHS gives GP teams direct access to tests to speed up cancer diagnosis

Tens of thousands of cancers could be detected sooner each year thanks to a national roll out of fast-track testing | via NHS England

NHS England is expanding direct access to diagnostic scans across all GP practices, helping cut waiting times and speeding up a cancer diagnosis or all-clear for patients. From this month, every GP team will start to be able to directly order CT scans, ultrasounds or brain MRIs for patients with concerning symptoms, but who fall outside the NICE guideline threshold for an urgent suspected cancer referral.

The scheme will allow GPs to order these checks directly, helping to cut down wait times to as little as four weeks. Hundreds of thousands of initial hospital appointments could also be freed up under the approach by reducing the need for a specialist consultation first – boosting efforts to address the Covid backlog.

Urgent cancer referrals have been at record levels since March 2021, with over a quarter of a million people (255,055) checked following an urgent GP referral in August – the highest number since records began.

Full detail: NHS gives GP teams direct access to tests to speed up cancer diagnosis

See also: Direct access to diagnostics will reassure patients – but GP workforce must be increased and given appropriate training and support | Royal College of General Practitioners

New clinical prediction model for early recognition of sepsis in adult primary care patients

British Journal of General Practice | Vol. 72 (719): e437-e445. DOI: https://doi.org/10.3399/BJGP.2021.0520

Early recognition and treatment of sepsis are essential to improve patient outcomes. Scoring systems such as the systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) are used in the hospital setting for suspected sepsis but are not validated in the primary care setting. This study presents a newly developed simple score-based model that may help to predict sepsis in adult primary care patients.

Based on this study’s GP out-of-hours population, a simple model can accurately predict sepsis in acutely ill adult patients using readily available clinical parameters. Before widely advocating the new model, effects on referrals and patient outcomes should be prospectively evaluated.

Full detail: New clinical prediction model for early recognition of sepsis in adult primary care patients: a prospective diagnostic cohort study of development and external validation

High street pharmacies spot cancers in new NHS early diagnosis drive

Staff in high street pharmacies will be funded to spot signs of cancer as part of a new drive to catch tumours early when they are easier to treat | NHS England

The NHS Long Term Plan committed to increasing the proportion of cancers caught early, when they are easier to treat, from half to three in four. The community pharmacy pilot, to be carried out in areas across the country, will see staff spot signs of cancer in people who might not have noticed symptoms. Those with symptoms including a cough that lasts for three weeks or more, difficulty swallowing or blood in their urine will be referred direct for scans and checks without needing to see a GP if staff think it could be cancer.

Full detail: High street pharmacies spot cancers in new NHS early diagnosis drive

See also: Pilot scheme will allow pharmacists to refer potential cancer cases directly to hospital | BMJ

Levelling up dementia diagnosis: Tackling variations in diagnosis rates in England

This research report from Future Health has been commissioned and funded by Roche Products Ltd to further the understanding of care for people with Alzheimer’s disease and other forms of dementia.

Future Health has published research which shows that over 300,000 people living with dementia in England go undiagnosed. The report finds:

• A postcode lottery for dementia diagnosis, with large variations across England, including between neighbouring healthcare authorities
• The pandemic has seen a reduction in the proportion of patients receiving a diagnosis, with the number falling below 60% – missing the Government target of two thirds
• £3billion could be saved with better diagnosis rates of dementia, as report calls for pandemic recovery investment and an urgent public health campaign to encourage people to visit their GPs if they have concerns

Full report: Levelling up dementia diagnosis: Tackling variations in diagnosis rates in England

Press release: New report reveals pandemic impact on dementia diagnosis

Factors affecting the decision to investigate older adults with potential cancer symptoms

British Journal of General Practice 2022; 72 (714): e1-e10.| DOI: https://doi.org/10.3399/BJGP.2021.0257

Older age and frailty increase the risk of morbidity and mortality from cancer surgery and intolerance of chemotherapy and radiotherapy. The effect of old age on diagnostic intervals is unknown; however, older adults need a balanced approach to the diagnosis and management of cancer symptoms, considering the benefits of early diagnosis, patient preferences, and the likely prognosis of a cancer.

The aim of this systematic review was to examine the association between older age and diagnostic processes for cancer, and the specific factors that affect diagnosis.

Thematic synthesis highlighted three important factors that resulted in uncertainty in decisions involving older adults: presence of frailty, comorbidities, and cognitive impairment. Data suggested patients wished to be involved in decision making, but the presence of cognitive impairment and the need for additional time within a consultation were significant barriers.

This review has highlighted uncertainty in the management of older adults with cancer symptoms. Patients and their family wished to be involved in these decisions. Given the uncertainty regarding optimum management of this group of patients, a shared decision-making approach is important.

Full paper: Factors affecting the decision to investigate older adults with potential cancer symptoms: a systematic review