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GPs pledge to donate ‘unethical’ diagnosis cash to local dementia care services

GPs at a practice in Kent have decided to donate any extra money they receive for diagnosing patients with dementia to a local dementia care day centre, in protest at what they said is an ‘unethical’ and ‘unnecessary’ Government scheme.

The GPs said they have decided to redirect money to the centre, rather than boycott the new Dementia Identification Scheme – launched last month by NHS England – altogether, in order to make a statement that the money would be better spent on improving care and support of people with dementia.

It follows widespread criticism of the new enhanced service, which will pay GPs £55 for each new patient they add to the dementia register from October to the end of March next year, in a bid to meet a Government target to have two-thirds of people thought to have dementia formally diagnosed by 2015.

There have been suggestions of a boycott of the enhanced service over claims that it amounts to ‘cash for diagnoses’ and could cause problems in the doctor-patient relationship.

But the decision by the Cedars Practice in Deal, Kent, represents the first example of a practice using the money to benefit local dementia services.

Dr Stephanie de Giorgio, a partner at the practice, told Pulse that the GP partners had come to the decision they would sign up for the scheme, but only on the agreement they would send any funding they receive as a result to the dementia day care service run locally at the Deal Centre.

She said: ‘When we heard about this [enhanced service] the practice decided that ethically we don’t agree with how it is being done, but we decided we would sign up to it and then if we got any money then we would donate it to the Deal Centre, because that is where the money is needed.’  

Dr de Giorgio emphasised that while the partners believe the scheme was unethical, they wanted to donate any funds in order ‘to make a point’.

She said: ‘We felt the scheme was wrong, we felt it was unethical. So to make a point we would sign up for it but give away the money to where it is actually is needed.’

Under the enhanced service specifications, GPs can either be paid for patients they referred to a memory clinic for the diagnosis to be made, or for diagnosing patients themselves.

The head of NHS England, Simon Stevens, recently rejected criticisms of the scheme, saying the money offered up for new diagnoses would pay for the extra work involved for GPs.

But Dr de Giorgio said that as well as being unethical, the payment did not make sense in terms of GPs’ role in diagnosing patients.

She said: ‘This fundamentally alters the doctor-patient relationship – that was our main ethical issue. But the practicalities of it is a bit of a farce really. I heard someone say this will fund GPs to spend the time making more diagnosis, but it won’t – it’s not a meaningful amount to do anything like that.’

Other practices hinted that they may adopt a similar approach to Dr de Giorgio’s in protest at the controversial scheme, which has been condemned by GP leaders and patient groups.

Dr Rebecca Pryse, a GP partner in Buckingham, tweeted: ‘I’ve agenda’d similar discussion next partners meeting.’

Dr Martin Brunet, a GP in Guildford who has campaigned vigorously against incentivising dementia diagnosis, told Pulse the donation was an ‘innovative way of getting round’ the problem, but that he felt NHS England should not be put GPs in a position where they needed to take such a decision.

Dr Brunet said: ‘I think it’s an innovative way of getting around it - good for them. For me, I’d rather not do it at all - that’s a good moral way of resolving it. I want to say that’s what all practices should do, but…  if we all did that, it would just get NHS England off the hook. They shouldn’t be asking us to do this and I really don’t want to have anything to do with this money at all.

‘We shouldn’t be in a position where money comes into the moment of diagnosis – there shouldn’t be incentives one way or the other.’

Readers' comments (16)

  • I don't think taking this money is unethical, the government are just trying to create a screening program on the cheap without putting all the usual resources to support its governance requirements.

    No-one questions funding of the cervical or breast cancer screening programs even if finding proof of benefit in a screen program is controversial. The government clearly think this is worthwhile because they need to plan and provide for the health and welfare of this cohort and there are expensive new dementia drugs in the pipeline.

    A large practice will use many hours of valuable nursing time on this service which you might consider unethical but dementia patients have been woefully under-severed for years and we cannot help them if we don't know who they are! After paying for the nursing this scheme really doesn't look that profitable and given the current state of general practice we need to chase all the money we can get if we are not to collapse in the current recruitment crisis.

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  • I think the whole concept of having to ''chase all the money we can get'' is the bane of bliss and a source of woe.
    Let's be rational - we screen and diagnose when our clinical intuition tells us to. Of course, if we had the resources, we could have somebody sitting just dealing with dementia screening.
    Maybe the government would start a screening service at par with the Breast, Retinal, AA or Bowel ca screening programme. Where does this end and are we as GPs going to be able to squeeze in those precious 10 minutes we have - enough time for a decent memory screen? Or would we be just coding boxes to get the money?
    But chasing money? No - that's not what an ordinary GPs intention was when he or she took up this noble profession.

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  • So you're doing all this crap for free?It will be far more ethical to say no to all this nonsense in the first place.

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  • I live with AD and while I was unsure the government made a good choice here, I do commend them for trying. I believe the problem lies with poor GP thoughts and even could be an ethical. While I believe the doctors her who are against it I believe they are the ones that truly care and would do the right thing. The very sad part many do not make it official for many reasons, such as, One lose their rights when they are labeled with it, What the sense to tell them because there is nothing they can do and many feel that they need to tell the caregiver and not the patient. While I believe we are tackling this the wrong way it may help a bit to get them to rethink how important it is to say they have the dementia. I would like to address the other issues including better education for those doctors.

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  • Vinci Ho

    Would you think we would end up with polarised arguments of do it or don't do it if the government had funded screening program with clearly defined objectives in the first place? Screening , not carpet screening ,has definitive criteria in medical sense.
    The public verdict on Stevens is his objective of achieving the so called target of reaching the anticipated number of dementia diagnoses in less than 5 months , is purely political . This is a political mission which he wants to drag GPs into it.
    This , ladies and gentlemen, is unethical.

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  • 6:19pm,

    No offence but you are a bit naive.

    As with any other project, there has to be a realization of the benefit. In order to do , valuation of the cost of the project hasohaso be plotted against the validity of the methodology of the screening and percentage of the false positive/negative diagnosis and negative effect of such diagnosis. It will also have to take into account of available treatment and it's impact on disease/QoL modification. This is why we have national screening committee.

    I've not seen any such evaluation. Any 1/2 decent manager involved at ccg level and above will know this as it is bread & butter of commissioning. I'm an ordinary grassroot GP and even I know this. Stevens will definitely be familiar with the concept. As Vinci pointed out, I suspect this is purely political.

    I feel rather insulted NHSE thinks we can't figure this out and we'll be defeated by greed.

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  • The sad truth is that there are many people with dementia who are not given the opportunity of diagnosis. And we are really talking about early diagnosis here not screening. The furore over this DES is achieving one important thing , raising the profile of dementia

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  • @7:29 - I don't think this is crap and I did not say whether I am taking up this or not. My point of view may seem contradictory but, to put the record straight, I have decided to go ahead and sign the agreement. I will screen and assess as I normally do when I feel there is the need without trying to 'chase money'. I will accept money given and use it to provide the necessary care to my patients. As a Practice that has 4150 patients and not enough funds to have a second full time GP, I think my patients will have better use for this than a Charity.

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  • Vinci Ho

    I would say 'Chase the Dragon' instead of 'Chase the Money' (remember this phrase ?).

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  • Vinci Ho

    A capitalist will have to think with a capitalist mentality . Logical. So all values can be bought and compensated with money .........

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