Working with your GP practice

What the GP does

The GP practice provides:

• Initial cognitive screening when memory concerns are raised;
• Referral to the memory clinic;
• Ongoing prescribing of anti-dementia medication under shared care;
• Management of comorbidities (blood pressure, diabetes, cholesterol);
• Annual dementia review (NICE NG97 1.2.10);
• Acute illness, including suspected Delirium;
• End-of-life care planning and provision;
• Sick certification and benefits supporting evidence;
• Co-ordination with social care, hospital and specialist services.

The annual dementia review

People diagnosed with dementia are on the GP's dementia register and should receive an annual review covering:

• Cognitive symptoms and any change since last review;
• Behavioural and psychological symptoms;
• Medication review (including anti-dementia medication and other medicines);
• Physical health: blood pressure, vascular risk;
• Mood and sleep;
• Carer wellbeing;
• Social and practical support;
• Advance care planning where appropriate.

Annual review may be a single appointment or a series. It may be conducted by the GP, a nurse practitioner, a community psychiatric nurse or a clinical pharmacist depending on local arrangements.

Shared care prescribing

Anti-dementia medication (Cholinesterase Inhibitors, Memantine) is typically initiated by the memory clinic and continued by the GP under shared care. The arrangement specifies:

• Who is responsible for monitoring;
• When to review;
• When to refer back to the specialist.

If you are seen privately and the private clinician recommends medication, your NHS GP can usually continue prescribing under shared care after seeing the structured letter. The Dementia Service provides a structured letter aligned to ICD-11 to support this.

Making the most of GP appointments

Before

• Write down concerns and questions, in order of priority;
• Bring a brief carer summary if helpful;
• Bring the medication list;
• Bring recent letters from specialists.

During

• Address the most important concern first;
• Ask for explanation of any unfamiliar terms;
• Confirm next steps before leaving (what will happen, when, who will do what);
• Ask for written information where useful.

After

• Confirm any referrals or tests have been actioned;
• Note when to follow up;
• Use the practice patient portal if available.

Telephone and online appointments

Many GP practices offer telephone, video and online consultations. For people with dementia, face-to-face is often easier; for carers, remote consultation can be useful for ongoing queries.

If the GP service is not working for you

Where you are not satisfied:

• Speak to the practice manager;
• Request a different GP within the practice;
• Use the practice's complaints procedure;
• Contact NHS England (or equivalent) if complaints are not resolved;
• Register with a different practice (most areas allow patient choice).

If your GP is reluctant to prescribe shared care

Where the GP is uncomfortable continuing private specialist recommendations, options include:

• Ensuring the private specialist letter is fully aligned with NICE guidance;
• Requesting NHS specialist referral for ongoing care under the NHS;
• Continuing private prescribing (more expensive but possible);
• A structured conversation with the GP about the shared-care arrangement.

Most GPs are willing to prescribe under shared care where the specialist is appropriately qualified and the letter aligns with NICE.