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GPs pledge to donate ‘unethical’ diagnosis cash to local dementia care services



GPs at a practice in Kent have decided to donate any extra money they receive for diagnosing patients with dementia to a local dementia care day centre, in protest at what they said is an ‘unethical’ and ‘unnecessary’ Government scheme.

The GPs said they have decided to redirect money to the centre, rather than boycott the new Dementia Identification Scheme – launched last month by NHS England – altogether, in order to make a statement that the money would be better spent on improving care and support of people with dementia.

It follows widespread criticism of the new enhanced service, which will pay GPs £55 for each new patient they add to the dementia register from October to the end of March next year, in a bid to meet a Government target to have two-thirds of people thought to have dementia formally diagnosed by 2015.

There have been suggestions of a boycott of the enhanced service over claims that it amounts to ‘cash for diagnoses’ and could cause problems in the doctor-patient relationship.

But the decision by the Cedars Practice in Deal, Kent, represents the first example of a practice using the money to benefit local dementia services.

Dr Stephanie de Giorgio, a partner at the practice, told Pulse that the GP partners had come to the decision they would sign up for the scheme, but only on the agreement they would send any funding they receive as a result to the dementia day care service run locally at the Deal Centre.

She said: ‘When we heard about this [enhanced service] the practice decided that ethically we don’t agree with how it is being done, but we decided we would sign up to it and then if we got any money then we would donate it to the Deal Centre, because that is where the money is needed.’  

Dr de Giorgio emphasised that while the partners believe the scheme was unethical, they wanted to donate any funds in order ‘to make a point’.

She said: ‘We felt the scheme was wrong, we felt it was unethical. So to make a point we would sign up for it but give away the money to where it is actually is needed.’

Under the enhanced service specifications, GPs can either be paid for patients they referred to a memory clinic for the diagnosis to be made, or for diagnosing patients themselves.

The head of NHS England, Simon Stevens, recently rejected criticisms of the scheme, saying the money offered up for new diagnoses would pay for the extra work involved for GPs.

But Dr de Giorgio said that as well as being unethical, the payment did not make sense in terms of GPs’ role in diagnosing patients.

She said: ‘This fundamentally alters the doctor-patient relationship – that was our main ethical issue. But the practicalities of it is a bit of a farce really. I heard someone say this will fund GPs to spend the time making more diagnosis, but it won’t – it’s not a meaningful amount to do anything like that.’

Other practices hinted that they may adopt a similar approach to Dr de Giorgio’s in protest at the controversial scheme, which has been condemned by GP leaders and patient groups.

Dr Rebecca Pryse, a GP partner in Buckingham, tweeted: ‘I’ve agenda’d similar discussion next partners meeting.’

Dr Martin Brunet, a GP in Guildford who has campaigned vigorously against incentivising dementia diagnosis, told Pulse the donation was an ‘innovative way of getting round’ the problem, but that he felt NHS England should not be put GPs in a position where they needed to take such a decision.

Dr Brunet said: ‘I think it’s an innovative way of getting around it – good for them. For me, I’d rather not do it at all – that’s a good moral way of resolving it. I want to say that’s what all practices should do, but…  if we all did that, it would just get NHS England off the hook. They shouldn’t be asking us to do this and I really don’t want to have anything to do with this money at all.

‘We shouldn’t be in a position where money comes into the moment of diagnosis – there shouldn’t be incentives one way or the other.’