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Leading doctors urge withdrawal of dementia ‘cash for diagnoses’ scheme



A group of leading GPs, consultants and health campaigners are urging the Government to scrap the controversial ‘cash for diagnosis’ dementia scheme.

In an open letter to NHS England chief executive Simon Stevens and dementia tsar Professor Alistair Burns, Pulse blogger Dr Martin Brunet and over 50 others – including BMA deputy chair Dr Kailash Chand – say the policy is unethical and should be withdrawn ‘without delay’.

The RCGP has also said that its ethics committee will be reviewing the scheme, to ‘arrive at a position’ that reflects the membership’s view on the issue.

The new Dementia Identification Scheme – revealed by Pulse last month – is offering GPs £55 for each new diagnosis of dementia they make from October to the end of March next year, in a bid to hit Government targets on diagnosis rates for 2015.

GP critics have condemned the policy, with some saying they will boycott it and others pledging to give the money to dementia care services ‘where it is needed’ in protest.

However, both Stevens and Professor Burns have defended it, insisting the money is being offered in recognition of extra work involved in diagnosing patients.

Now Dr Brunet and colleagues including Dr Chand, former RCGP president Dr Iona Health and former GPC chair Dr Laurence Buckman have urged NHS England to reconsider.

In the letter, published in the BMJ, Dr Brunet and co-signatories argue the policy ‘has broken new ground in the national GP contract’ and sets a ‘dangerous precedent’.

They say the direct payment for diagnosis undermines the ‘basis of trust inherent in the doctor-patient relationship’ and cite the public’s reaction as evidence of the concerns around the ethics of such payment.

They write: ‘The reaction of the general public to the story is a demonstration of the widespread concern that the policy is unethical, and we ask for it to be withdrawn without delay.’

Other signatories include RCGP council member Dr Margaret McCartney, GPC clinical and prescribing subcommittee chair Dr Andrew Green, RCGP prescribing advisor Dr Martin Duerden, and leading GP campaigners on over-diagnosis Dr John Cosgrove and Dr Julian Treadwell, as well as consultant clinical associate to the Academy of Medical Colleges Dr Aseem Malhotra, Patients Association chief executive Katherine Murphy, the retired nurse and dementia campaigner Sally-Ann Marciano and dementia campaigner Beth Britton.

Meanwhile, RCGP chair Dr Maureen Baker has told Pulse: ‘This is a difficult issue which is dividing opinion amongst the profession and causing concern for our patients and their carers. We have asked the College’s ethics committee to consider this and help us arrive at a position that appropriately reflects the views of our membership.’

NHS England national clinical director for long-term conditions Dr Martin McShane said the payment was to ensure every patient with dementia ‘gets the best treatment and the right support as early as possible’.

He said the payment was ‘not for individuals’ and would be ‘unlikely to amount to more than a few hundred pounds’.

Dr McShane said: ‘Dementia is an absolutely devastating condition, and there are too many people undiagnosed who are being denied the care they need. As the population ages, we cannot tinker at the edges. We need to make a fundamental breakthrough, a step change.’ 

He added: ‘Our aim is that every patient with dementia gets the best treatment and the right support as early as possible. To achieve this, we need both GPs and the public to be on the alert, spot the signs early and either seek help or get patients the help they need.

‘It would be wrong to overstate the level of financial incentive. These are paid to GP practices – not individuals – and are unlikely to amount to more than a few hundred pounds a year.’

>>>> Clinical Newswire