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GPs buried under trusts' workload dump

GPs to be paid £150 to diagnose and treat dementia

Exclusive GPs in the West Midlands are set to be paid £150 per patient to diagnose and treat dementia as part of a scheme to cut delays to diagnosis caused by pressures on memory clinics.

NHS Dudley CCG said the incentive scheme will see GPs diagnosing and initiating the treatment of the ‘less complicated’ cases of dementia, mainly in the elderly - or refer them to another GP practice that will.

It comes as NHS chiefs have called for GPs to take more responsibility for diagnosis and care of patients with dementia, after the Government's dementia strategy saw specialist memory assessment clinics become overwhelmed with referrals.

The CCG said the initiative was designed to help cut delays in diagnosis in line with 'national guidance that well-trained, experienced GPs can diagnose dementia once it is established'.

Commissioners proposed the measures after finding that locally patients currently wait an average of 13 weeks to be seen by the local memory clinic.

The CCG spokesperson said they hope the scheme ’will take the pressure off the dementia assessment service so that patients with milder dementia or abnormal presentations can be assessed by specialists much sooner’.

The scheme, which launches this month, requires GPs to attend initial training with a consultant psychogeriatrician, after which they will be asked to ‘consider diagnosing dementia, predominantly in patients over the age of 75, when they feel confident to do so and the diagnosis is less complicated’, said NHS Dudley CCG.

Under the incentive scheme, practices will be paid:

  • £150 for each patient they diagnose (whether it’s their own patient or one referred onto them);
  • or, £50 for each patient they refer on to another practice who subsequently receives a diagnosis from that practice.

GPs will also be expected to initiate anticholinesterase treatment in patients they diagnose ‘if they feel safe doing so’, with advice on hand from practice based pharmacists ‘if required’.

Younger patients and those in risk groups will continue to be referred to the dementia assessment service, the CCG said, adding that GP practices would be subject to 'a thorough assessment' to qualify for payment under the scheme.

Dr David Hegarty, NHS Dudley CCG chair and a GP in Stourbridge, said: ‘Our aspiration is not to persuade GPs to diagnose dementia but to facilitate information so GPs can feel safe about diagnosing dementia in certain clinical situations.

‘In the future, rather than referring all people to the dementia assessment service for diagnosis we hope to encourage more GPs to make that diagnosis quickly in primary care. This is in direct response to the feedback we have had from carers about the impact of a delayed diagnosis.’

But Dr Uzma Ahmad, West Midlands GPC representative, said: 'I really would be interested to see how it will materialise as I don’t really think GPs have the time. 

'Although they say it is just easy, less complicated cases in over-75s – ok some cases may be easier, but they can still be tricky – you cannot reach a diagnosis until you make a proper careful assessment that takes time and we don’t have the time at the moment to do that.'

NHS England introduced a controversial DES in mid-2014/15 which paid GPs £55 for every patient dementia diagnosis they made by the end of the financial year, to help hit the Government's target of two-thirds of the estimated population with dementia to have a diagnosis.

But NHS chiefs did not renew the scheme after outcry from some in the GP profession who said it amounted to 'cash for diagnosis' and was 'unethical'.

The dementia diagnosis drive

Networks of memory clinics were specifically set up to deal with the diagnosis drive under the previous Government’s dementia strategy – with the imposition of an unpopular ‘dementia DES’ under which GPs were incentivised to screen patients for memory problems and refer anyone considered at risk to the clinics for specialist assessment.

GP critics warned at the time that the DES would lead to memory clinics becoming swamped with referrals for mild or inconsequential memory impairment, leading to delays in diagnosis for those with more serious illness. The GPC opposed its introduction.

The Dudley initiative follows long-term calls from NHS England dementia tsar Professor Alistair Burns for GPs ‘upskilled’ to take on more diagnosis and care of dementia, to help ease backlogs in referrals to memory clinics, and Government plans for GPs to start managing dementia like other long-term conditions.

An investigation by Pulse last year revealed that the dementia screening DES - which was expanded two years ago before being dropped from last year's GP contract - had led to massive rise in the proportion of patients referred to memory clinics who turned out not to have dementia - or 'false alarms'.

 

Readers' comments (20)

  • Why on earth do the GPs need to be paid to make this one diagnosis and not all the others? This feels completely unethical

    Refer and the £150 stays in the NHS to support secondary care services (not indiviual doctors), or don't refer and you get to pocket all the dosh. The cost to the CCG is identical. No cnflict of interest there then!

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  • So just what exactly does a GP expect to do for his/her basic salary? Seems diagnosing common conditions is no longer in their purvue so I wonder what else they might consent to sully their hands with without additional immoral payments such as this?

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  • Wait so we get "advanced" nurse practitioners to do the GPs job, and we get GPs to do the psychiatrists job...how is this not clearly a downgrade of the entire system?

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  • In other news, GPs paid to do £250 to do appendicies in house, £500 for stents and £1k for neurosurgery. Just need a consultant mentor and see one, do one teach one. Robust CQC inspection done. Can even do it for neighbouring surgery of part of STP's. come one and come all. Patients have a preference for GPs doing this than the long wait at a hospital with trained professionals to do it. Recovery happens in GPs living room, which the GP partners also paid for.

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  • AlanAlmond

    So what do you do with your nice new shiny dementia diagnosis..get your Dr to cure it? Diagnosing an incurable end of life disease is apparently £150 more important than anything else we might be diagnosing is it? We don't get £150 for picking up each case of childhood leukaemia for some reason, or testicular cancer. why is that exactly?? Less important?? Less curable?? This kind of outrageous political pressure group inspired crap makes me want to scream.

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  • More absurd thrashing about whilst Rome burns
    GP does not have the time nor to train up
    Pathetic

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  • What a waste

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  • The problem locally is the the Dementia diagnosis is the gateway to social services, benefits, carers etc and SS do not accept a normal GPs diagnosis so you have to go on extra training to be able to diagnose it so that it is acceptable to SS. But it also allows the GP to take over the prescribing of the Rx. Without the "proper" diagnosis no Rx & no SS support. Mad!

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  • Memory clinic too full? Diabetes Clinic over-run? Long wait at gender dysphoria clinic? Simple - get GPs to do it.

    Dementia is one of those diagnoses we used to make until it was deemed to need a referral to a memory clinic and a CT head for everyone. Funny how once clinics are full the diagnosis and assessment becomes much more 'simple'.

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  • So there will be a surge in Dementia diagnostics!
    Another effect of the brexit??!!

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