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GPs go forth

Cash for dementia diagnoses ‘draws attention’ to under-diagnosis, says NHS long-term conditions tsar

Paying GPs directly for diagnosing dementia is ‘not perfect’ but will help to draw GPs’ attention to the condition and the need to improve diagnosis rates, an NHS England chief has said.

Dr Martin McShane, NHS England’s clinical lead for long-term conditions, said the payments had ‘stimulated a lot of interest’ and would keep GPs focused on getting two-thirds of patients with dementia diagnosed by next year, in line with Government targets.

Dr McShane’s comments came as patient groups and dementia charities criticised NHS England’s plans, which they said ‘distorted’ the patient-doctor relationship and could potentially exacerbate problems around the lack of support for patients already diagnosed.

Pulse revealed this week that NHS England had set up a new ‘Dementia Identification Scheme’, which would see GPs being paid £55 for every diagnosis they made between now and April 2015.

However, GPs strongly criticised the scheme, saying it amounted to ‘cash for diagnoses’ and an ‘ethical travesty’.

Speaking at the Best Practice conference in Birmingham, Dr McShane defended the scheme and said GPs in England ‘had a long way to go’ to improve their diagnosis rates.

He said: ‘These payments are to keep it on their radar, raise awareness, and look, this draws attention to it… Is it perfect? No, of course it’s not perfect. But it’s highlighted that we still have a long way to go to even catch up with Scotland. Scotland has a 70% diagnosis rate, we’ve got a 53% [rate] in England, we’ve got a shedload more people and some practices have a very high burden.

‘We’re not asking for 100%, we’re not asking for 80%. We’re actually saying that we want practices to think about reaching two-thirds, because all the evidence suggests that that’s absolutely achievable, clinically appropriate and reasonable.’

Dr McShane indicated that NHS England is still considering whether to continue the new initiative next year.

He said: ‘Well this is only until April, we’re still looking at. We have an imperfect payment system, and I can’t reform that overnight, but we do want to support general practice, it’s a bloody difficult challenge.

‘[We are] not just looking at general practice. I’m challenging, internally, local authorities and the support that social care can bring to bear… General practice is not alone in this, we need to challenge the whole of society about this problem.’

However, patient groups and charities supporting dementia patients questioned the new initiative.

A spokesperson for Dementia UK said: ‘Whilst we understand the benefits of a push to diagnose two-thirds of people with dementia by April 2015, we have some concerns about these plans… Do GPs really need a financial incentive? Many good GPs are already doing this to support families, but many are hesitant because of the dearth of follow-up care.

‘These plans suggest that we’re able to give people better quality of life if diagnosed much earlier, but that would depend solely on our ability to deliver high-quality post-diagnostic support. The fact is that, as a country, we’re not currently delivering this support in a consistent way… We are also concerned about how the memory assessment services are going to cope with the increased numbers of referrals, as many already have long waiting lists.’

The spokesperson added: ‘We would add caution about financially incentivising GPs to diagnose when we know that diagnosis is complex and needs to be timely, rather than early. There is no guarantee that the prevalence figures that the targets are based on are accurate, and so the Government may be pressurising GPs to find and diagnose a number of people who simply don’t exist.’

Katherine Murphy, chief executive of the Patients Association, condemned the plans ‘as a distortion of good medical practice’ and ‘a step too far’.

She said: ‘We know GPs receive incentive payments to find all sorts of conditions, such a high cholesterol, raised blood pressure and diabetes – but this seems a step too far. It is putting a bounty on the head of certain patients.

‘Good GPs will be diagnosing their dementia patients already. This seems to be rewarding poor GPs. It is a distortion of good medical practice. There is an issue of people presenting late with dementia to doctors, but this is not the right way to go about tackling that. If people were given hope that something could be done, that would be the greatest incentive for coming early.’

Readers' comments (11)

  • Weren't the Tsars out of touch with reality? Like the big boys in Westminster who have no idea of what the NHS is about and keep on churning out wierder fairy tales every day.

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  • Its October we need a revolution .

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  • Vinci Ho

    Chinese saying,' 10,000 arrows fired towards the heart'.
    I have got a gut feeling this chap is a 'scapegoat' target ..............

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  • Dr Macshane. It time to fall on your sword.

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  • Just one of a whole range of special interest groups claimng their particular illness of interest is more important than anyone else illness of interest. This particular issue is David Cameron's pet subject and so gets special funding at the expense of other ill people because it goes down well with a particular group of voters ... politically motivated rubbish

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  • Martin,You should have stuck with surgery,old chap.

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  • The problem with these tsars is that they are beholden to their political masters; they learn to spin and lie. I am always suspicious of the term best practice, promulgated as it is by nurse managers with clip boars demonstrating just what an oxymoron that precise term, nurse manager, is!!

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  • Yup..fodder for the Daily Wail..GPs want yet more money to diagnose common conditions!..has this guy absolutely no sense of what would happen if his policy were to be extrapolated?? overdiagnosis, overinvestigation perhaps at the expense of other diseases.

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  • This comment has been moderated.

  • Just finished those useful care plans in time..tick.
    Right..dementia diagnosis. This MUST be useful and cost effective too...seem to remember something about Wilson rules, but that must be rubbish now (the clever people on government must know what they are doing)? I must go on an update course for my appraisal, I've obviously missed the bit about cost effective treatment for dementia and all people wanting to be tested?
    Haaaang on....this is just another inch of utter s*&yte to wade through every fricking day!!!
    CQC, revalidation/appraisal, 7 day opening, I'm lazy/greedy, get paid too much, the media bending us over a barrel every other day with a hefty toxic enema of GPs are sh*&te at XY and Z.
    Too many groups want to tinker with what we do and I feel like I'm starting to drown under the never ending avalanche of bureaucracy - we need to take action and kick our representatives into positive action. The GMC is part of the problem so they should be scrapped.

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  • words fail me
    utter utterly unacceptable pre election demagogic crap..more pretence of action by disingenuous schemery for the unaware electorate to deflect attention whilst hunt and cameron destroy the nhs secretively and corruptly by the unmandated evil of 2012.
    has dr mcshane forgotten how professionals act?
    why try to force people to be diagnosed when patient or family perceive there is no need especially as we all know there is no effective treatment even for alzheimers...all you do is cause is cause distress and dr dependency by intruding on some proud elderly people and betrays total ignorance of how with a longterm trusting relationship a gp can help a patient at his/her pace without coercion..this bullying nhse immoral stupid and disgraceful and will lead to loss of trust/compliance with their dr to the detriment of their care.
    all this will achieve is wastage of resources and time away from real clinical need and worse further damage the dr.patient relationship as they feel we no longer give independent advice but on basis of money...already critically damaged by QOF which is ninety per cent cloud cuckoo fantasy dreamed up by out of touch academics with no understanding of quality patient focussed individualised care.
    how dr mcshane can be that craven to have anything to do with this execrable misguided nonsense is beyond me..except to say it is typical of the serial tsunami of moronic nonevidence based manure emanating from the hopeless quango NHSE which just does what whitehall tells it..and then hunt can claim..nothing to do with me..actually about right as he is incapable of taking responsibility for anything.
    please please gpc time to consider industrial action to bring down this corrupt incompetent government with its brain dead quango/lapdog NHSE....can we not as a body of respected professionals Refuse to have anything to do with any nonevidence based schemery which gpc etc drags a proud profession into disrepute by prostituting us to political lunacy ....for cash!
    at least gpc and rcgp are at last..long last starting to show some backbone in refusing to comply with what we all know damages patient care on so many levels as well as being a primary cause of low morale by degrading our professional ethic both for us and worse our public image..both are real and direct causes of poor care..gpc and rcgp...
    incredible how out of touch..or malignantly bullying..or both nhse is... a complete failure well suited to simple simon with his naked agenda and outrageous conflict of interest with his united health shares.
    best way to help the nhs..sack all in nhse then cremate the building.

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  • "Scotland has a 70% diagnosis rate, we’ve got a 53% [rate] in England"

    So maybe Scotland has a higher incidence of dementia? Just because they have a higher diagnosis rate does not mean somehow GP's in England are poorer at diagnosing dementia. If Scotland or Wales for that matter have a higher diagnosis rate for ingroing toenails are GP's in England going to get paid some more money to increase rate of diagnosis because clearly England must have at least as much people with dodgy nails than the neighbours!

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