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Leading doctors urge withdrawal of dementia 'cash for diagnoses' scheme

A group of leading GPs, consultants and health campaigners are urging the Government to scrap the controversial ‘cash for diagnosis’ dementia scheme.

In an open letter to NHS England chief executive Simon Stevens and dementia tsar Professor Alistair Burns, Pulse blogger Dr Martin Brunet and over 50 others - including BMA deputy chair Dr Kailash Chand - say the policy is unethical and should be withdrawn ‘without delay’.

The RCGP has also said that its ethics committee will be reviewing the scheme, to ‘arrive at a position’ that reflects the membership’s view on the issue.

The new Dementia Identification Scheme - revealed by Pulse last month - is offering GPs £55 for each new diagnosis of dementia they make from October to the end of March next year, in a bid to hit Government targets on diagnosis rates for 2015.

GP critics have condemned the policy, with some saying they will boycott it and others pledging to give the money to dementia care services ‘where it is needed’ in protest.

However, both Stevens and Professor Burns have defended it, insisting the money is being offered in recognition of extra work involved in diagnosing patients.

Now Dr Brunet and colleagues including Dr Chand, former RCGP president Dr Iona Health and former GPC chair Dr Laurence Buckman have urged NHS England to reconsider.

In the letter, published in the BMJ, Dr Brunet and co-signatories argue the policy ‘has broken new ground in the national GP contract’ and sets a ‘dangerous precedent’.

They say the direct payment for diagnosis undermines the ‘basis of trust inherent in the doctor-patient relationship’ and cite the public’s reaction as evidence of the concerns around the ethics of such payment.

They write: ‘The reaction of the general public to the story is a demonstration of the widespread concern that the policy is unethical, and we ask for it to be withdrawn without delay.’

Other signatories include RCGP council member Dr Margaret McCartney, GPC clinical and prescribing subcommittee chair Dr Andrew Green, RCGP prescribing advisor Dr Martin Duerden, and leading GP campaigners on over-diagnosis Dr John Cosgrove and Dr Julian Treadwell, as well as consultant clinical associate to the Academy of Medical Colleges Dr Aseem Malhotra, Patients Association chief executive Katherine Murphy, the retired nurse and dementia campaigner Sally-Ann Marciano and dementia campaigner Beth Britton.

Meanwhile, RCGP chair Dr Maureen Baker has told Pulse: ‘This is a difficult issue which is dividing opinion amongst the profession and causing concern for our patients and their carers. We have asked the College’s ethics committee to consider this and help us arrive at a position that appropriately reflects the views of our membership.’

NHS England national clinical director for long-term conditions Dr Martin McShane said the payment was to ensure every patient with dementia ‘gets the best treatment and the right support as early as possible’.

He said the payment was ‘not for individuals’ and would be ‘unlikely to amount to more than a few hundred pounds’.

Dr McShane said: ‘Dementia is an absolutely devastating condition, and there are too many people undiagnosed who are being denied the care they need. As the population ages, we cannot tinker at the edges. We need to make a fundamental breakthrough, a step change.’ 

He added: ‘Our aim is that every patient with dementia gets the best treatment and the right support as early as possible. To achieve this, we need both GPs and the public to be on the alert, spot the signs early and either seek help or get patients the help they need.

‘It would be wrong to overstate the level of financial incentive. These are paid to GP practices - not individuals - and are unlikely to amount to more than a few hundred pounds a year.’

>>>> Clinical Newswire

Readers' comments (10)

  • Vinci Ho

    There is a clear difference between the disease register in QOF and Stevens' Screening :
    (2)The former is opportunistic when patient presents with certain specific symptoms e.g. polyuria and polydispia in diabetes. There is no targeted number of new cases to be found in short space of time in QOF ,investigations and specific management are covered by further QOF points.(remember how much each QOF point is worth?)
    (2)Stevens' Screening is a carpet screening to reach a targeted number of new cases in less than 5 months because this government had unilaterally made a political claim that it can do a lot more for dementia. Now it is running out of time heading towards bankruptcy of trust and credibility

    I just hope people can understand .........

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  • It's pretty simple.

    Make services better for people with dementia and more people will be diagnosed. The problems is that is just too expensive and demented people are just not important enough for this conservative government to help.

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  • 1. There is an enormous difference between paying for work done in assessing people for dementia and paying for a diagnosis. The first could be ethical, the second is not.
    2. Having a father with Alzheimer's I can say that the timing of the diagnosis and the way it was handled was critical. This is a sensitive area and diagnosis to fit a financial window is also unethical. The patient and their family need to be in control of how this happens, not the doctor or the NHS beurocrats.

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  • For years we have been "paid" to diagnose a variety of conditions.
    In all QOF clinical conditions, the greater our register, the higher the payment.
    Whats the fuss about diagnosing dementia?
    If it is diagnosed, it will allow better care (that would otherwise never be initiated).

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  • QOF payments are higher when prevalence is higher because of the extra work involved. QOF money is not payment for a diagnosis but payment for providing quality care to those with the diagnosis; that is the difference.

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  • @10:30 no it isn't the fact is simple qof is just as unethical. it's just that various arguments have been built up to sustain QOF and we have got used to it. we have to question what the purpose of our patient interactions is. is it qof or the patient we are treating. i suspect for a lot of people qof is the main purpose of the consult. ban qof its unethical

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  • @10.40 I beg to differ. I use QOF as a prompt to improve overall care and hope to be rewarded accordingly. Perhaps there is a difference between those of us who were practising before QOF and those who have known nothing else. I believe, however, that there is a fundamental difference between the concept of QOF and the dementia proposition.

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  • I repeat, the PATIENT must be in control of the timing of the diagnosis and have the conversation at a time and in a way that suits them.
    The realisation that there may be an issue is generally gradual and the timing of a diagnosis or assessment should not be influenced in any way by a doctor's financial gain.

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  • nothing wrong with cash for diagnosis plans.the more the better

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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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