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Independents' Day

GPs to be paid £55 for every dementia diagnosis under new identification scheme

GPs will be paid £55 per patient for each additional dementia diagnosis they make over the next six months in a radical move by NHS England to hit targets that GP experts said amounts to ‘cash for diagnoses’ and an ‘ethical travesty’.

The payment is part of a new ‘Dementia Identification Scheme’ unveiled by NHS England, which follows the contract agreement announced this month and sees GP practices paid for the net increase in dementia diagnoses they record from now until next April.

GPC negotiators said they had again opposed the incentivisation of dementia diagnoses during recent negotiations for the 2015/16 GP contract and insisted they ‘did not have sight of nor approve’ the new enhanced service specification, while the RCGP said that practices who have already diagnosed cases in a timely way will be penalised.

The move has renewed controversy over the Government’s focus on raising GP diagnosis rates as part of its national dementia strategy, following reports that some CCGs were paying practices £200 for every diagnosis.

NHS England has introduced the new scheme as part of a £5 million funding boost for general practice, announced by chief executive Simon Stevens at the RCGP conference, to ‘spearhead the NHS drive to identify people with dementia’.  

The service – which is optional for GPs – pays for diagnoses only, with payment based on the net increase in the dementia register at the end of March 2015, compared with the end of September 2014.

The service specification states: ‘NHS England will pay GP practices an achievement payment of £55 per additional patient, based upon the differential between the agreed dementia registers of 30 September 2014 and 31 March 2015.’

To qualify for payment, practices either have to make sure patients diagnosed in hospital or a memory clinic have their patient record updated, or they can diagnose patients themselves if ‘the GP determines that it is not necessary to refer a patient with suspected dementia’.

The Government is committed to getting two-thirds of people with dementia diagnosed by next year, after claiming less than half of patients affected were getting a formal diagnosis.

GPs have been paid to carry out assessments for dementia in at-risk groups for the past two years, under an enhanced service promoting ‘timely diagnosis and support’ for dementia that was imposed in the 2013/14 contract, although critics have questioned to what extent dementia is under-diagnosed and recent figures suggested diagnosis rates have changed little as a result of the scheme.

The new service has now prompted outcry from GPs who have opposed the Government’s strategy on raising GPs’ diagnosis rates from the start.

Dr Iona Heath, former RCGP president and a GP in north London, who, along with other leading GPs campaigned to block the introduction of the 2013/2014 dementia case-finding DES, told Pulse: ‘I think the proposal is an intellectual and ethical travesty.’

Dr Martin Brunet, a GP in Godalming, Surrey, said the payment arrangement ‘crosses a line’ ethically in paying practices directly to make a diagnosis.

Dr Brunet said: ‘It crosses a line that has not been crossed before – the direct payment on the basis of making a diagnosis, or “cash for diagnoses”. We are used to being paid for items of service under QOF, but what is unique about the diagnosis is that patients have to trust us – they cannot opt out of it like they can with aspects of QOF.’

Dr Richard Vautrey, deputy chair of the GPC, stressed that negotiators did not approve the new service and continued to resist the focus on GP diagnoses.

Dr Vautrey said: ‘This is not a jointly negotiated enhanced service, it’s something NHS England wanted to do. Practices will have to make their minds up as to how they will approach it and I’m sure they will have lots of issues with it. It’s just until the end of the year, to see whether this particular scheme makes any difference to the variation in diagnosis rates.

‘But as we’ve made it clear to both NHS England and the Department of Health that the problem isn’t diagnosis, it’s about getting support services to patients with dementia and this enhanced service won’t address that.’

Dr Maureen Baker, chair of the RCGP, said: ‘It is… important to ensure that GP practices do not become a victim of their own success at diagnosing patients with dementia in a timely fashion. Whilst the 66% target might sound ambitious, many GP practices around the country are already achieving this and it is important that practices exceeding this target do not lose out on more money and resources.’

A spokesperson for NHS England said: ‘Dementia can be devastating both for individuals and their families. We know that more needs to be done across the health service to ensure that people living with dementia are identified so that they can get the tailored care and support they need. This additional investment is part of a drive to ensure this.’

Related images

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Readers' comments (37)

  • This is totally ridiculous, obviously but even if you did believe in this, doesn't it punish practices that were very good at making the diagnosis prior to Sep 2014?

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  • Put a bounty on these poor patients heads,very dubious .

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  • Targets is all NHS is about now. With the system in ruins, there are jokers giving incentives for a senseless exercise - a a promise made to a drug manufacturer maybe to boost sales. Who's demented? if I may ask. It's almost as if they were saying that stupid GPs don't identify dementia until they are paid.

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  • £55 per diagnosis.........!!!!

    Less income tax, superannuation and possibly some staff costs in administration time and it really doesn't leave a lot.

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  • Bob Hodges

    £55 doesn't even pay for the consultation time to do the MMSE/6CIT, make the referral and do the bloods required prior to the referral and then make the claim.

    However, on a positive note, it's once to see some recognition that additional workload should be coupled to additional funding which until recently would have been a completely novel concept.

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  • If GPs accede to this then medicine is no longer a profession. We really need to seperate the idea of Doctors from the NHS. Doctors should regard themselves as part of a profession who essentially contract their services. As a profession we should be clearly saying I'm sorry but this type of payment is unacceptable to us. The BMA need to do this.

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  • Ultimately its cash for Daily Mail headlines and Daily Mail voters - and no doubt privatised dementia care...

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  • Gettting paid for work done! What a novel concept! Who else but DOH can think of such scheme!!!
    If its true for dementia why not for every diagnosis.

    What happens after Dx. Mild cognitive impairment has no proven treatment. Social services can`t cope with existing problems leave alone new patients with mild dementia.
    Unless of course the idea is to get maximum prevalence for poltical reasons and make them pay for their help/care by selling their houses!

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  • And I wonder who is going to end up on the board of, or as an adviser to, pharmaceutical companies after retirement from politics. If this is not driven by the lobbying of industry, after more profits for very little benefit to patients I might bother voting again.

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  • If diagnosis depends on under-resourced Memory Clinics (as it should) can this financial incentive make any difference to the diagnosis rate within 6 months?
    (When was this announced and when will it be offered? We're already 7 weeks into the 6 months allowed...)
    Is this the real reason for collecting - and publishing - QOF dementia register numbers on a monthly basis?

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