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Independents' Day

A 10% jump in recorded dementia since introduction of 'cash for diagnosis' scheme

The total number of patients on GP lists with a diagnosis of dementia has jumped by 10.3% since the temporary £55-per-diagnosis incentive scheme was rolled out to GP practices in September last year.

Statistics published by the Health and Social Care Information Centre (HSCIC) today, focused on the period between April 2014 and January 2015, showed that the total number of dementia diagnoses rose by 12% during the period as a whole - from 331,824 to 371,244. However, the vast majority of these diagnoses were made since September.

The total number rose by 39,420, but 34,799 diagnoses were made since September and just 4,621 between April and September.

The proportion of patients with a dementia diagnosis on GPs lists also edged up from April 2014 to January 2015 - from 0.643% to 0.703%.

The figures come in the wake of the enhanced service which pays GP practices £55 per patient for each additional dementia diagnosis they make from the end of September 2014 until the end of March 2015. The scheme attracted critique from GP leaders who called it an ‘ethical travesty’ and described the incentive as ‘cash for diagnoses’.

But if the impact on diagnosis rates are a direct result of the scheme, this marks a contrast to the dementia case-finding DES that came with the 2013/14 GP contract, which had little impact on total numbers.

Overall, NHS England has a goal of increasing the dementia diagnosis rate to 67% by March 2015. If this is achieved two-thirds of the estimated number of people with dementia would receive a formal diagnosis and access to appropriate post-diagnosis support.

Readers' comments (7)

  • Dementia attacks the Head which causes decay of the system.

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  • Our practice was never part of the GP payment DES for dementia. Yet the CCG was constantly on our backs with telephone calls and emails asking (telling) us to check coding, recheck those who might be not coded, bring forward those demented but not fully investigated.

    When challenged they stated they were under political pressure to increase the diagnosis rate.

    And so it has happened.

    This isn’t the payment, this is DoH and the politicos getting what they wanted.

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  • We reviewed all patients on our list who didn't have a diagnosis code for dementia but who had been given a dementia drug at some point and all patients with codes like 'memory loss'. We then reviewed their notes and found a number of patients who had already been given a formal dementia diagnosis by the dementia team but who had not had a dementia code added to their probem list ie we hadn't replaced memory loss with dementia. We thus boosted our formal register by 10%. Each one we will be paid £55 for. Each one will now be invited for annual dementia qof review. Each one we were already seeing annually for some sort of chronic disease or medication or nursing home review. So in summary our coding is better but we have not diagnosed more dementia.

    There may be some modest benefit to these people in terms of recall but I suspect it will make zero difference to them clinically. After all, they already had dementia diagnosed and were mostly already under regular review by the dementia team.

    I will be interested to see what the Daily Mail tries to make this headline mean. On second thoughts I am not really interested. It is a story about coding and registers not people.

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  • The comments above - 8.49 and 10.43 - based on experience since this financially rewarded and politically incentivised target was put in place demonstrates a determinism that would appear not to be about people but about the system.

    I agree with Dr Brunet that this is an unethical approach. An approach that risks causing harm. The Alzheimer Society are “leading the fight” as “take a look at our early diagnosis campaign” reveals:

    In October 2014, I believe I am correct, the CEO of Alzheimer Society signed the “Glasgow Agreement” which enshrines the right for a timely diagnosis of dementia. The Alzheimer Society seem to have forgotten this. Perhaps the CEO, Jeremy Hughes has a “right to know” that such forgetfulness may be early dementia.

    The Dementia Tsar would appear to support the approach taken by Alzheimer Society. Given I have tirelessly advocated for the timely diagnosis of dementia I do not agree with the Dementia Tsar that “doctors are in the driving seat”. I do agree though that patients are in the back-seat, perhaps even in the trailer.

    In Scotland, some years back, we had a similar incentivised target. We are now finding that many of those with memory loss, but within the range of the parabolic distribution with age, were as a result of the TARGET misdiagnosed as having "early dementia" or "early Alzheimer's diesease". All of these patients had post-diagnostic counselling for a condition they do not have. They have lost their autonomy, been redefined, pay higher insurance, may no longer be driving ..... their voice is lost. I worry about their “rights”

    Dr Peter J Gordon

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  • Woopy do...a bunch of unfortunate people with dementia are now on a list. Money well sent?

    This gonna cure their dementia?...urrrr no
    This gonna provide social care to keep them at home?...urrrr no
    His gonna fund memory clincs?....urrrr no

    This gonna look good in a newspaper and work well for some scum bag slime politican....absolutamente!

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  • Samuel Lewis

    There seems to me to be much politicking in posturing about dementia, and not enough considered thought and good science.

    Of course it's a good thing to identify dementia accurately, if only to enable access to care planning and possible medication trials. A £55 incentive may or may not be the best way of doing it, but it's hardly unethical given that all QOF registers work that way..

    The Alzheimer Society believe the problem is under-diagnosis, and have persuaded Jeremy Hunt to trial this experimental case-finding initiative. In fact this 10% increase in case identification is consonant , and not in contrast, with the 9% increase that came with the 2013/2014 DES.

    But this new prevalence study shows that dementia rates and numbers are falling ! This is NEWS !! We may argue that dementia-modifying anticholinesterases are more hype than fact, but SOMETHING is causing dementia numbers to fall whilst elderly numbers increase !!

    Let us focus on identifying what it is we must be doing right ... maybe it really is down to QoF incentivisation of CVD prevention, hypertension and diabetes management !!

    May we continue to live in interesting times.

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  • Samuel Lewis

    Substantial decline in dementia rates...

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