GPs will be paid £55 per patient for each additional dementia diagnosis they make over the next six months in a radical move by NHS England to hit targets that GP experts said amounts to ‘cash for diagnoses’ and an ‘ethical travesty’.
The payment is part of a new ‘Dementia Identification Scheme’ unveiled by NHS England, which follows the contract agreement announced this month and sees GP practices paid for the net increase in dementia diagnoses they record from now until next April.
GPC negotiators said they had again opposed the incentivisation of dementia diagnoses during recent negotiations for the 2015/16 GP contract and insisted they ‘did not have sight of nor approve’ the new enhanced service specification, while the RCGP said that practices who have already diagnosed cases in a timely way will be penalised.
The move has renewed controversy over the Government’s focus on raising GP diagnosis rates as part of its national dementia strategy, following reports that some CCGs were paying practices £200 for every diagnosis.
NHS England has introduced the new scheme as part of a £5 million funding boost for general practice, announced by chief executive Simon Stevens at the RCGP conference, to ‘spearhead the NHS drive to identify people with dementia’.
The service – which is optional for GPs – pays for diagnoses only, with payment based on the net increase in the dementia register at the end of March 2015, compared with the end of September 2014.
The service specification states: ‘NHS England will pay GP practices an achievement payment of £55 per additional patient, based upon the differential between the agreed dementia registers of 30 September 2014 and 31 March 2015.’
To qualify for payment, practices either have to make sure patients diagnosed in hospital or a memory clinic have their patient record updated, or they can diagnose patients themselves if ‘the GP determines that it is not necessary to refer a patient with suspected dementia’.
The Government is committed to getting two-thirds of people with dementia diagnosed by next year, after claiming less than half of patients affected were getting a formal diagnosis.
GPs have been paid to carry out assessments for dementia in at-risk groups for the past two years, under an enhanced service promoting ‘timely diagnosis and support’ for dementia that was imposed in the 2013/14 contract, although critics have questioned to what extent dementia is under-diagnosed and recent figures suggested diagnosis rates have changed little as a result of the scheme.
The new service has now prompted outcry from GPs who have opposed the Government’s strategy on raising GPs’ diagnosis rates from the start.
Dr Iona Heath, former RCGP president and a GP in north London, who, along with other leading GPs campaigned to block the introduction of the 2013/2014 dementia case-finding DES, told Pulse: ‘I think the proposal is an intellectual and ethical travesty.’
Dr Martin Brunet, a GP in Godalming, Surrey, said the payment arrangement ‘crosses a line’ ethically in paying practices directly to make a diagnosis.
Dr Brunet said: ‘It crosses a line that has not been crossed before – the direct payment on the basis of making a diagnosis, or “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.’
Dr Richard Vautrey, deputy chair of the GPC, stressed that negotiators did not approve the new service and continued to resist the focus on GP diagnoses.
Dr Vautrey said: ‘This is not a jointly negotiated enhanced service, it’s something NHS England wanted to do. Practices will have to make their minds up as to how they will approach it and I’m sure they will have lots of issues with it. It’s just until the end of the year, to see whether this particular scheme makes any difference to the variation in diagnosis rates.
‘But as we’ve made it clear to both NHS England and the Department of Health that the problem isn’t diagnosis, it’s about getting support services to patients with dementia and this enhanced service won’t address that.’
Dr Maureen Baker, chair of the RCGP, said: ‘It is… important to ensure that GP practices do not become a victim of their own success at diagnosing patients with dementia in a timely fashion. Whilst the 66% target might sound ambitious, many GP practices around the country are already achieving this and it is important that practices exceeding this target do not lose out on more money and resources.’
A spokesperson for NHS England said: ‘Dementia can be devastating both for individuals and their families. We know that more needs to be done across the health service to ensure that people living with dementia are identified so that they can get the tailored care and support they need. This additional investment is part of a drive to ensure this.’