We need to think very carefully about this DES, as it crosses a line that has not been crossed before – the direct payment on the basis of making a diagnosis: ‘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, for example, declining to take a statin or come for an asthma check. You can’t ask to be exception reported from a diagnosis. Patients are at their most vulnerable when we make a diagnosis, because it is the doctor’s judgement and so very difficult for the patient to challenge it.
The payment is not on the basis of caring for our patients, but only the diagnostic label we apply – this creates a major conflict of interests that is frankly unethical.
Should we declare this interest to the patient when we make a diagnosis? If an insurance salesman were to make more money selling us one policy over another we would expect them to be transparent that it had financial implications for them.
And what about misdiagnoses? If we decide that someone has been misdiagnosed with dementia and remove that erroneous label then it will cost us £55 to do that.
Dr Martin Brunet is a GP in Guildford and director of the Guildford GPVTS