Perverse Incentive? GPs to be paid £55 for each dementia diagnosis. “…an intellectual and ethical travesty.”

BBC News reports 22nd October 2014: GPs to be paid £55 for each dementia diagnosis

NHS chiefs said the aim was to increase the number of sufferers who receive treatment for the condition, which causes a decline in brain function.

But the Patients Association called it “a step too far” that would mean a “bounty on the head” of some patients.

Fewer than half of the 800,000 people in the UK who are estimated to have dementia have been formally diagnosed.

Dementia is an umbrella term used for a collection of symptoms resulting from a number of different diseases of the brain.

There are many types but all tend to affect brain function and cause problems with memory, mental agility, language skills, and the ability to carry out everyday tasks.

‘Devastating’ condition

Under the scheme, doctors would receive the money for every extra patient given a diagnosis of dementia over a six-month period.

NHS England said it was “not just payment for diagnosis” and GP practices would have to form a detailed plan and show improving diagnosis rates.

Dr Martin McShane, national director for long term conditions at NHS England, said: “Dementia can be devastating both for individuals and their families….

The Perverse nature of being paid to make a diagnosis may mean that English GPs get paid more than those in the other regions if they don’t accept the change. But, since it is almost certain that life expectancy will be better in England in the years ahead, the other regional systems could gain by having less sufferers! Prevalence knowledge is important, but so is dignity. There is no more money. The QOF points system for rewarding GPs has been doctored so that there is less for kidney disease and coronary heart disease… (BMA news 14th October 2014).

Pulse reports 21st October: GPs to be paid £55 for every dementia diagnosis under new identification scheme and Chris Smith in The Times reports Iona Heath’s comments as: “Iona Heath, the former president of the Royal College of GPs, told Pulse magazine: “I think the proposal is an intellectual and ethical travesty.” ”

When I was a GP I initially marked the patient notes with an annotation such as “memory loss symptom” and then say 12 months later “memory loss” when the mini mental showed underperformance. When the ability of the patient to communicate properly with others, or their labile temperament or melancholia became more obvious I would make a note “cognitive decline”. Everyone in the practice knew what I was getting at, and without having to confront the patient their decline was recorded. At what point should the diagnosis of dementia be made and at what point given to the patient? It has been a matter of judgement between doctor and patient + relatives up to now. During this experimental period I expect many patients and relatives to be upset. There is the added issue that those practices who have been making the diagnosis and recording it (along with the CAT and MRI scans) will lose out compared to those who have avoided making the diagnosis whenever possible up to now.

Update 6th November 2014. Chris Smyth in The Times: Dementia payment ‘is unethical’

Doctors have urged the NHS to scrap its “cash for diagnoses” scheme that offers GPs £55 for every case of dementia they spot.

They say the “unethical” plan sets a dangerous precedent that could undermine patients’ trust in doctors. Health chiefs countered that doctors were unlikely to be swayed by a few hundred pounds a year towards surgery running costs……



This entry was posted in A Personal View, Perverse Incentives, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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