3. What support can the GP give?
GPs and the practice team (eg nurses and healthcare assistants) can offer a range of support to a person with dementia, including:
- general advice on ways of preventing illness and promoting fitness
- support with care planning for the future
- medical advice and treatment
- referrals to specialist help and other services
- continuity of care (the GP will remain a key contact point for the person with dementia and those around them as the dementia progresses)
- support with managing any other conditions the person may have, eg diabetes or Parkinson's disease
If you think that you, or someone you know, may have dementia but it has not been diagnosed, see our page: Assessment and diagnosis.
The GP can also support the person with dementia in the specific ways outlined below.
Often the GP will be the first person that someone goes to if they (or someone close to them) are worried about their memory. For many people, their doctor remains the main point of contact as dementia progresses.
GPs will often be involved in the process of a diagnosis, either directly making a diagnosis themselves or by referring people to specialist services.
When a person goes to see the doctor because they are worried about their memory, there are certain steps a GP will take. They should record notes about the person's medical history and anyone who accompanies them, if appropriate. They may also ask the person to complete a brief memory assessment - eg drawing a clock from memory, or remembering three words. They are also likely to perform a blood test to rule out other possible causes. In some cases the GP may be able to make a diagnosis based on the outcome of this process. If not, they will refer the person on to a specialist service, such as a memory clinic (a service that assesses people who have memory problems, especially suspected dementia) or neurologist (a doctor who specialises in disorders of the brain and nervous system for a diagnosis.
Getting a timely diagnosis is important because it can help the person to make decisions about what they want for the future, and to plan their care with those supporting them and the health and social care teams.
If the person has been diagnosed with Alzheimer's disease, or mixed dementia where Alzheimer's disease is the main cause, they should be offered drugs to help manage the dementia. The drugs that can help with this are:
- galantamine (known as cholinesterase inhibitors)
These drugs should only be given by a health professional with the appropriate knowledge and skills. This could be a specialist such as a psychiatrist or neurologist, or a GP, nurse consultant or advanced nurse practitioner who has specialist knowledge of diagnosing and treating Alzheimer's disease. If the person is started on drugs for Alzheimer's disease by a specialist, the GP will often take over responsibility for ongoing prescriptions of the drugs, once the person is taking the medication at the right dose for them. For more information see our section: Drug treatments for Alzheimer's disease.
The GP or a pharmacist can advise on any medication the person needs to take. It can help to ask the GP or pharmacist:
- what each drug is for
- how and when it should be taken
- what the effects are likely to be
- whether there are any side effects to watch out for.
If any drug appears to be having a side effect, contact the doctor straightaway. They may need to change the drug or the dose.
The GP should talk to the person about next steps following a diagnosis. This should include talking to them about driving. If the person is driving and the GP has diagnosed them with dementia, they should inform the person that they need to notify their insurer and the DVLA (DVA in Northern Ireland). For more information see the page: Driving and dementia.
The GP can also make the person aware of planning for the future. They can talk to the person and those supporting them about the care and support that they might want in the future, including at the end of life, and can support this care. Talking about wishes for the future is especially important for people with dementia, and those around them, as they may not be able to make decisions for themselves later on.
The person may want to set up an advance decision, advance statement and Lasting Power of Attorney. For more information see our page: Advance decisions and advance statements, and 472, Lasting power of attorney (in Northern Ireland see our page: Enduring power of attorney and controllership).
Behaviours that challenge
If the person with dementia behaves in ways that challenge them or their carer - eg if they are agitated or restless - it will be helpful to see the GP. The person may be communicating a need when they behave in this way, and the doctor should be able to rule out any physical causes such as an infection or pain that could be contributing to the behaviour. They may also be able to offer information and support around the behaviours or refer them on to a specialist service if appropriate - eg a community mental health team. This is a of mental health professionals such as social workers, community psychiatric nurses and occupational therapists who work in the community to support people's mental health.
The GP and practice staff can also give information to the person and those who care for them, about support that is available in the local area. This includes support from social services and local organisations. For more information see 'Other services' below.
Helping the person stay well
The GP will also be able to help with general wellbeing and advice, and support the person to manage any other health conditions. Treating even what seem to be minor complaints can make a big difference to a person's wellbeing.
The GP and practice staff can provide support for carers as well. For more information see the section on carers below.
How can a GP practice support a person with dementia and their carer?
GP practices are an important part of a dementia-friendly community and there are many things a GP practice can do to support people with dementia and those caring for them. Many GP practices are already dementia friendly. It may be helpful to ask the practice if they provide extra support for people with dementia and carers - many do.
The following suggestions may help a person with dementia and their carer.
- A note on the file to ask the person if they need any extra support when visiting the practice.
- A reminder system for appointments - eg a phone call an hour before the appointment to remind the person.
- Longer appointments so the person has time to say what they want to.
- Staff who have had dementia awareness training.
- Asking the GP practice if they have a dementia champion.
- Making sure the person sees the same GP each time (if they want to). If the person is over 75 they should have access to a named GP.
- Providing regular health checks and an annual flu jab.
- Asking the person to identify their main carer. This means the carer can be offered support and they can discuss plans for emergency care.
- Notifying carers of relevant information, where appropriate. For example, dates and times of hospital appointments the person with dementia has been referred for.
- Offering the carer a regular health check.
- Referring both the person with dementia and their carer to other organisations for information and support, eg local Alzheimer's Society or Age UK.
- Adapting the environment to be more suitable to a person with dementia. This could include improving lighting, adding signs (eg for the toilet or to the consultation rooms) and having a 'quiet' area for people to wait in.