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Cash for dementia diagnoses ‘draws attention’ to under-diagnosis, says NHS long-term conditions tsar



Paying GPs directly for diagnosing dementia is ‘not perfect’ but will help to draw GPs’ attention to the condition and the need to improve diagnosis rates, an NHS England chief has said.

Dr Martin McShane, NHS England’s clinical lead for long-term conditions, said the payments had ‘stimulated a lot of interest’ and would keep GPs focused on getting two-thirds of patients with dementia diagnosed by next year, in line with Government targets.

Dr McShane’s comments came as patient groups and dementia charities criticised NHS England’s plans, which they said ‘distorted’ the patient-doctor relationship and could potentially exacerbate problems around the lack of support for patients already diagnosed.

Pulse revealed this week that NHS England had set up a new ‘Dementia Identification Scheme’, which would see GPs being paid £55 for every diagnosis they made between now and April 2015.

However, GPs strongly criticised the scheme, saying it amounted to ‘cash for diagnoses’ and an ‘ethical travesty’.

Speaking at the Best Practice conference in Birmingham, Dr McShane defended the scheme and said GPs in England ‘had a long way to go’ to improve their diagnosis rates.

He said: ‘These payments are to keep it on their radar, raise awareness, and look, this draws attention to it… Is it perfect? No, of course it’s not perfect. But it’s highlighted that we still have a long way to go to even catch up with Scotland. Scotland has a 70% diagnosis rate, we’ve got a 53% [rate] in England, we’ve got a shedload more people and some practices have a very high burden.

‘We’re not asking for 100%, we’re not asking for 80%. We’re actually saying that we want practices to think about reaching two-thirds, because all the evidence suggests that that’s absolutely achievable, clinically appropriate and reasonable.’

Dr McShane indicated that NHS England is still considering whether to continue the new initiative next year.

He said: ‘Well this is only until April, we’re still looking at. We have an imperfect payment system, and I can’t reform that overnight, but we do want to support general practice, it’s a bloody difficult challenge.

‘[We are] not just looking at general practice. I’m challenging, internally, local authorities and the support that social care can bring to bear… General practice is not alone in this, we need to challenge the whole of society about this problem.’

However, patient groups and charities supporting dementia patients questioned the new initiative.

A spokesperson for Dementia UK said: ‘Whilst we understand the benefits of a push to diagnose two-thirds of people with dementia by April 2015, we have some concerns about these plans… Do GPs really need a financial incentive? Many good GPs are already doing this to support families, but many are hesitant because of the dearth of follow-up care.

‘These plans suggest that we’re able to give people better quality of life if diagnosed much earlier, but that would depend solely on our ability to deliver high-quality post-diagnostic support. The fact is that, as a country, we’re not currently delivering this support in a consistent way… We are also concerned about how the memory assessment services are going to cope with the increased numbers of referrals, as many already have long waiting lists.’

The spokesperson added: ‘We would add caution about financially incentivising GPs to diagnose when we know that diagnosis is complex and needs to be timely, rather than early. There is no guarantee that the prevalence figures that the targets are based on are accurate, and so the Government may be pressurising GPs to find and diagnose a number of people who simply don’t exist.’

Katherine Murphy, chief executive of the Patients Association, condemned the plans ‘as a distortion of good medical practice’ and ‘a step too far’.

She said: ‘We know GPs receive incentive payments to find all sorts of conditions, such a high cholesterol, raised blood pressure and diabetes – but this seems a step too far. It is putting a bounty on the head of certain patients.

‘Good GPs will be diagnosing their dementia patients already. This seems to be rewarding poor GPs. It is a distortion of good medical practice. There is an issue of people presenting late with dementia to doctors, but this is not the right way to go about tackling that. If people were given hope that something could be done, that would be the greatest incentive for coming early.’