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GPs go forth

Over 40% of GPs prepare to sign up for 'cash for diagnosis' dementia scheme

Exclusive: Over 40% of GPs in England are preparing to sign up for the £55 ‘cash for diagnosis’ dementia scheme, even though many disagree with it on ethical grounds.

A Pulse survey of nearly 500 GPs shows that 43% of GPs say they have already signed up for the Dementia Identification Scheme or intend to sign up for it by the deadline of 17 November.

This is despite two-thirds (66%) of respondents to the survey saying they believed the new enhanced service was unethical. Many argued that the incentive would not change their practise and they were only taking part in it because of cash flow problems.

The scheme - revealed by Pulse last month - will pay GPs £55 for each additional dementia diagnosis if they show a net increase on their practice register from October to the end of March next year in a bid to hit Government targets on raising diagnosis rates in 2015.

It has been condemned by GP leaders and a group of more than 50, including Pulse blogger Dr Martin Brunet and BMA deputy chair Dr Kailash Chand have written to NHS England chief executive Simon Stevens and dementia tsar Professor Alistair Burns, saying the policy is unethical and should be withdrawn ‘without delay’.

In the Pulse survey 34% said they had not signed up to the scheme so far, but 11% said they would before the deadline.

Dr Peter Swinyard, chair of the Family Doctors Association, told Pulse his practice will participate in the enhanced service, despite being ‘deeply cynical’ about the policy.

He said: ‘We’re not going to change our practise because of it. But if there are people who get diagnosed properly with dementia during that time then so be it, we will take the £55.’

Dr Simon Ruffle, a GP partner in Reading, similarly felt his practice could not turn down any potential extra income. He said: ‘Making payments linked to diagnosing conditions in patients seems wrong and open to abuse. [But] we have signed up to the scheme as our funding is continuing to be outstripped by wages, expenses, pension and national insurance payments.’

Dr Ivan Camphor, secretary of mid-Mersey LMC a GP on the Wirral, who has signed-up for the scheme, told Pulse he did not see a ‘moral issue’ with the scheme. He said: ‘The only moral issue I see is that we’re trying to help our patients with early diagnosis and providing them with appropriate information to signpost them to the appropriate services.’

Dr Richard Vautrey, deputy chair of the GPC told Pulse: ‘Whilst practices will have serious concerns about the scheme itself, the key is how they go about working with patients with memory loss within the consultation. And if they need to [sign up], I am sure they will uphold the highest professional standards when doing that and won’t be motivated by the resource issue. Nevertheless that is clouding some consultations from a patient’s perspective. Even with the best clinical judgement, these things can cause a problem from the patient’s point of view.’

Dr Martin McShane, NHS England’s national clinical director for people with long-term-conditions said: ‘This survey captures the views of a small number of GPs, but we know we have a lot of support from the GP community who agree early diagnosis is beneficial. This is a voluntary scheme so GPs do not have to sign up if they do not want to. However, we are still encouraging all GPs to make early diagnosis where appropriate.’


Survey results

NHS England has introduced a new dementia identification scheme that pays GPs £55 for every additional dementia diagnosis practices make before April 2015. Have you signed up already?

Yes 32%

Not yet, but planning to before the deadline 11%

No 23%

Don’t know 34%


Do you think this scheme is ethical?

Yes - 21%

No - 66%

Don’t know - 13%

The survey launched on 31 October 2014, collating responses using the SurveyMonkey tool. The 31 questions covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. Some 475 GPs answered these questions.

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Readers' comments (10)

  • Vinci Ho

    Nigel ,
    The Sumsung HD TV could be easily branded by our Nemesis as the 'bribe' to do your survey! But we are all demented by this government anyway, ha ha ha😵😲

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  • This is all a bit silly. It's a ridiculous scheme, but I suspect our practice will sign up.


    It won't change what we do AT ALL, but even if its a few hundred extra pounds it will still help us pay for the reception staff / nurse / toner / toilet paper etc etc

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  • Dumb idea - yes

    Future for general practice - no

    Is anything political ever ethical - no

    Have I signed up for other dumb schemes - yes, such as care plans

    Am I leaving partnership - no, but planning to

    Have politicians, BMA, RCGP, GPC, CQC destroyed my job - most certainly

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  • Dumb idea - yes

    Future for general practice - no

    Is anything political ever ethical - no

    Have I signed up for other dumb schemes - yes, such as care plans

    Am I leaving partnership - no, but planning to

    Have politicians, BMA, RCGP, GPC, CQC destroyed my job - most certainly

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  • I'm sorry if I sound altruistic but sometimes, you've got to stand up for your principles.

    I'm not suggesting your principles should be same as mine, if you feel this is ethically wrong, stop making excuses and don't do it! Otherwise the politicians will happily push your boundaries back and will give you more and more work you disagree on.

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  • @1:36

    There is a lot wrong in GP land. QOF is a good example but various excuses are used to defend it. it has completely changed how some doctors view patients. Funnily enough other countries can cope without it. The dementia scheme is no different. QOF is unethical but little complaint as it continue to march on. We are trained to be doctors - if there is doubt about the diagnosis of dementia do not give the diagnosis. If you are doing the work why not get paid for it?

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  • "Those are my principles, and if you don't like them, well, I have others"
    Groucho Marx

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  • Anon@3.50pm
    The dementia scheme is very different in my view. The concept of QOF (albeit subject to political whims) is payment for reaching a standard of care above the basic. Payment for a net increase in patients with a particular condition, on the other hand, is (a) implying that we are deliberately not making the diagnosis, (b) risking the doctor-patient relationship at a time of particular sensitivity and (c) appears to be purely politically driven to achieve a random target based on someone's estimate (which I understand has already been questioned).

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  • Took Early Retirement

    Martin- LOL! I had forgotten that one!

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  • NHS Scotland had a financially incentivised approach to the "early diagnosis" of dementia. This was HEAT Target 4. The target was reached and the Scottish Government were triumphant about this presenting the achievement to Westminster in 2012 (All Party Parliamentary Group)

    NHS Board in Scotland took robust measures to reach the target and thus gain the financial reward. Practice became skewed in many ways to reach the target.

    This target was set by the Scottish Government. The most Senior Official for Mental Health in the Government (Mr Geoff Huggins) stated that the Government had been careful "to take out saboteurs" and that any disagreement by doctors or managers would be dealt with "behind the bike shed".

    Wind on nearly 4 years and it is emerging that elderly patients were mis-diagnosed with "early dementia" as a result of this target. In fact they have static age-related memory loss and not dementia.

    Scotland stands as evidence emerges of the harmful effects of an incentivised target based on "early diagnosis". It is no light matter to make a wrong diagnosis. Ask those mis-diagnosed.

    I personally campaigned across the United Kingdomfor an approach based on a TIMELY approach to diagnosis. This approach was completely rejected by the Scottish Government throughout my "engagement" with them. But CURIOUSLY the Scottish Government are now taking credit for a timely approach to diagnosis. This is quite sickening as Scotland could have offered an important lesson had the Scottish Government been open, honest and shown probity.

    I agree with all those who say that chasing a crude uncertain population target, a target that is politically motivated and has been promoted RELENTLESSLY by the Alzheimer's Society is UNETHICAL.

    This approach risks generating a huge amount of fear. It also risks medicalising too much of ageing such that those living with dementia are further disadvantaged as services get ever more stretched.

    Above all a TARGET like this, an I realise that NHS England call it an “ambition”, ignores complexity and the parabolic distribution of cognition over our life course. Our elder generation deserve far far better.

    Dr Peter J. Gordon
    Psychiatrist for Older Adults
    NHS Scotland

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