November 2025 Update

Following concerns raised by GPs regarding the recent pattern of referral rejections from the Memory Clinic service the LMC has written to RDaSH outlining the issues.

Colleagues have reported multiple instances where referrals have been declined for reasons not clearly outlined in the referral documentation. These include:

• Recent hospital admission, despite discharge summaries recommending memory clinic referral
• Prior referral to talking therapies
• Alleged omission of the 6CIT score, which had in fact been included

These inconsistencies have been causing understandable frustration and risk delaying timely assessment and support for patients with suspected cognitive impairment. The lack of transparent exclusion criteria on the referral form compounds the issue, leading to duplicated clinical work and potential gaps in care.

On behalf of colleagues, the LMC asked the following questions:

1. Clarify the current triage criteria and any exclusion thresholds used by the service
2. Confirm whether recent hospitalisation or talking therapy involvement are considered grounds for rejection
3. Review the referral form to ensure it reflects all necessary information and exclusions
4. Consider a joint discussion with primary care representatives to improve mutual understanding and reduce avoidable rejections

Response to the questions below:

• Ahead of referral criteria is based on the presenting patient expressing concern regarding their memory including onset, length of history (lasting 6 months or more) and progression and impact of daily life. Primary Care would be expected to exclude any treatable illnesses and review any medication to identify any which may impair cognitive function. Exclusion criteria would apply to patients who have experienced delirium within the previous 3 months including urinary tract infections, chest infection, constipation, dehydration etc. This waiting period is to ensure that the patient returns to their optimum level. Recommended dementia blood screens should be taken and reviewed before referral: to rule out metabolic and endocrine Disorders
  Hypothyroidism
  Vitamin B12 deficiency
  Vitamin D deficiency*
  Folate deficiency
  Hypercalcemia or hypocalcaemia
  Electrolyte imbalances
  A cognitive screening e.g. 6CIT should also be completed.  Scores of 0-7 are considered normal 8 or more significant and evidence of 6CIT

• Referrals will be triaged by a senior member of the RDASH team, including team managers and healthcare professionals. The referral will be reviewed to look for the following information:
  • Presenting problem (e.g., various ways dementia can present, such as memory loss, confusion, mood changes, or behavioural disturbances)
  • What work has been completed to rule out pseudo-dementia (conditions that mimic dementia, like depression or medication effects)
  • If essential we will contact the patient or their next of kin, to obtain further information
  • At this stage to referral is accepted or declined.
  • Hospitalisation would only be an excluding factor if the criteria above is applied. Talking Therapy involvement is not considered grounds for a rejected referral.

A review of RDASH’s referral form is underway by RDASH’s Service Manager to ensure that this reflects all necessary information and exclusions.