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Why have we signed up for a dementia scheme we don't believe in?

Dr Stephanie de Giorgio says her practice is giving its proceeds to the local dementia centre

When we heard about the new dementia identification scheme, the GP partners at my practice agreed we did not agree with it ethically.

The new payment scheme fundamentally alters the doctor-patient relationship. It sets a very scary precedent for doctors to be paid to find diseases.

We need our patients to believe that everything we do is in their best interests, and if they have any concerns we might diagnose them with something because we are paid to do so, that is a very dangerous, slippery slope for us to start going down.

The practicalities of the payment are also somewhat farcical. If we refer patients for diagnosis this payment is not being used for anything – it is simply a ‘bonus’ payment for any patient who is diagnosed.

And while GPs can diagnose memory loss, we can only make a guess as to the subtype of dementia – we cannot give a specific diagnosis, because we cannot do that in the time allowed. This money will not create the extra time or GPs we would need.

Moreover, some social services will not accept a GP diagnosis of dementia to agree a person’s ongoing care needs – because of the need for longer investigations. We have expert memory clinics for this reason.

One of the arguments that has been made for raising diagnosis rates has been that if you make more diagnoses the funds will follow. This is not true, because the funds are needed in social care – and with social care budgets under pressure you are not going to make any change to the care that the patient receives upon diagnosis.

It is true GPs are already paid for different bits and pieces of work, and we have become used to this with QOF and so on. However, that is for managing disease. It is very different to be paid for diagnosing disease and we need to have a proper discussion about the ethics of this kind of payment.

So - despite all of these objectoins - why have we decided as a practice to sign up for it?

We have said we would sign up for the new scheme, but give away the money to where it is actually is needed – that is, in providing care and support for people with dementia and offering respite for their carers.

Any money we receive to the the Deal Centre, a local organisation helping in caring for those with dementia.

I believe NHS England should call a halt on this. It would do better to spend the money on social care for patients with dementia because that is where the problem lies, not in making the diagnosis.

Dr Stephanie de Giorgio is a GP in Deal, Kent

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Readers' comments (4)

  • Vinci Ho

    (1)While there is absolutely no doubt early diagnosis of dementia is vital , like any other illnesses e.g. Lung cancer , ovarian cancer , rheumatoid arthritis , diabetes(the list goes on forever) , Stevens' idea of 'screening' so as to catch up the anticipated number of dementia cases currently under-diagnosed IN less than 5 months time is a sign of ignorance and arrogance .
    (2) According to this DES, whenever we saw a patient with chest infection , for instance , we would have to start poking into the subject if the patient was 'old' and ask 'have you had any concern of your memory?' There is no difference to sending this patient to CXR or CT scan right away to exclude lung cancer if this £55 was for detecting early diagnosis of lung cancer instead.
    (3) Criteria of screening so as to fulfil its well defined objective(s) must be clear and funding must be appropriate for diagnosis , investigations and treatment(s). In this case , even funding for all support of the carer(s) and family. Please do not insult the intelligence of medical professionals, Mr Stevens.
    (4) Furthermore the money will only be paid if the practice reaches certain target number of new cases from now to April next year. Wow, we have 'a lot of' time! The toxic temptation is for one to sacrifice time from other care to 'chase the money' , as another commentator commented. I would call it 'chase the dragon' instead because it is toxic
    (5) Political crisis needs a political solution .Don't you dare to drag GPs into a political mission to please your bosses !
    (6) A capitalist will think and act with a capitalist mentality. Logical . So ALL values can be bought and compensated with money.

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  • Well said Dr De Georgio and if you are the same De Giorgio that questioned Jeremy Hunt on video at the recent RCGP conference about denegrating our profession double well said. I only wish other more probing questions were asked of him and his political and financial NHS motives: he got away very lightly indeed.

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  • The problem I have with it is being paid for making the diagnosis, rather than for testing or treating.

    Why?

    Because testing or treating can only be done with patient consent. If the patient doesn't want the test or treatment they can vote with their feet.

    But a doctor can (and in general does) make a diagnosis without patient consent.

    That is why patients must be able to have confidence that our diagnosis-making process is fair and unbiased - which a £55 "diagnosis payment" undermines.

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  • Samuel Lewis

    there is a simpler solution, surely ?

    we should collect the £55 for each patient on the dementia register, which should be defined as all patients referred and confirmed by specialist diagnosis.

    If doctors falsely diagnosed patients they could be found out at QOF visit time. If they did not meet all the dementia care and blood test criteria they would be shooting themselves in the QOF dementia domain foot .

    Its no different to Diabetes or CHD or hypertension , except that the patient potentially lacks the competence to informed dissent ?

    is that what the furore is about ?
    .. or is it just an emotive 'last straw' reaction to rising workload and diminishing income ??

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