Exclusive: Over 40% of GPs in England are preparing to sign up for the £55 ‘cash for diagnosis’ dementia scheme, even though many disagree with it on ethical grounds.
A Pulse survey of nearly 500 GPs shows that 43% of GPs say they have already signed up for the Dementia Identification Scheme or intend to sign up for it by the deadline of 17 November.
This is despite two-thirds (66%) of respondents to the survey saying they believed the new enhanced service was unethical. Many argued that the incentive would not change their practise and they were only taking part in it because of cash flow problems.
The scheme – revealed by Pulse last month – will pay GPs £55 for each additional dementia diagnosis if they show a net increase on their practice register from October to the end of March next year in a bid to hit Government targets on raising diagnosis rates in 2015.
It has been condemned by GP leaders and a group of more than 50, including Pulse blogger Dr Martin Brunet and BMA deputy chair Dr Kailash Chand have written to NHS England chief executive Simon Stevens and dementia tsar Professor Alistair Burns, saying the policy is unethical and should be withdrawn ‘without delay’.
In the Pulse survey 34% said they had not signed up to the scheme so far, but 11% said they would before the deadline.
Dr Peter Swinyard, chair of the Family Doctors Association, told Pulse his practice will participate in the enhanced service, despite being ‘deeply cynical’ about the policy.
He said: ‘We’re not going to change our practise because of it. But if there are people who get diagnosed properly with dementia during that time then so be it, we will take the £55.’
Dr Simon Ruffle, a GP partner in Reading, similarly felt his practice could not turn down any potential extra income. He said: ‘Making payments linked to diagnosing conditions in patients seems wrong and open to abuse. [But] we have signed up to the scheme as our funding is continuing to be outstripped by wages, expenses, pension and national insurance payments.’
Dr Ivan Camphor, secretary of mid-Mersey LMC a GP on the Wirral, who has signed-up for the scheme, told Pulse he did not see a ‘moral issue’ with the scheme. He said: ‘The only moral issue I see is that we’re trying to help our patients with early diagnosis and providing them with appropriate information to signpost them to the appropriate services.’
Dr Richard Vautrey, deputy chair of the GPC told Pulse: ‘Whilst practices will have serious concerns about the scheme itself, the key is how they go about working with patients with memory loss within the consultation. And if they need to [sign up], I am sure they will uphold the highest professional standards when doing that and won’t be motivated by the resource issue. Nevertheless that is clouding some consultations from a patient’s perspective. Even with the best clinical judgement, these things can cause a problem from the patient’s point of view.’
Dr Martin McShane, NHS England’s national clinical director for people with long-term-conditions said: ‘This survey captures the views of a small number of GPs, but we know we have a lot of support from the GP community who agree early diagnosis is beneficial. This is a voluntary scheme so GPs do not have to sign up if they do not want to. However, we are still encouraging all GPs to make early diagnosis where appropriate.’
NHS England has introduced a new dementia identification scheme that pays GPs £55 for every additional dementia diagnosis practices make before April 2015. Have you signed up already?
Not yet, but planning to before the deadline 11%
Don’t know 34%
Do you think this scheme is ethical?
Yes – 21%
No – 66%
Don’t know – 13%
The survey launched on 31 October 2014, collating responses using the SurveyMonkey tool. The 31 questions covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. Some 475 GPs answered these questions.