When we heard about the new dementia identification scheme, the GP partners at my practice agreed we did not agree with it ethically.
The new payment scheme fundamentally alters the doctor-patient relationship. It sets a very scary precedent for doctors to be paid to find diseases.
We need our patients to believe that everything we do is in their best interests, and if they have any concerns we might diagnose them with something because we are paid to do so, that is a very dangerous, slippery slope for us to start going down.
The practicalities of the payment are also somewhat farcical. If we refer patients for diagnosis this payment is not being used for anything – it is simply a ‘bonus’ payment for any patient who is diagnosed.
And while GPs can diagnose memory loss, we can only make a guess as to the subtype of dementia – we cannot give a specific diagnosis, because we cannot do that in the time allowed. This money will not create the extra time or GPs we would need.
Moreover, some social services will not accept a GP diagnosis of dementia to agree a person’s ongoing care needs – because of the need for longer investigations. We have expert memory clinics for this reason.
One of the arguments that has been made for raising diagnosis rates has been that if you make more diagnoses the funds will follow. This is not true, because the funds are needed in social care – and with social care budgets under pressure you are not going to make any change to the care that the patient receives upon diagnosis.
It is true GPs are already paid for different bits and pieces of work, and we have become used to this with QOF and so on. However, that is for managing disease. It is very different to be paid for diagnosing disease and we need to have a proper discussion about the ethics of this kind of payment.
So – despite all of these objectoins – why have we decided as a practice to sign up for it?
We have said we would sign up for the new scheme, but give away the money to where it is actually is needed – that is, in providing care and support for people with dementia and offering respite for their carers.
Any money we receive to the the Deal Centre, a local organisation helping in caring for those with dementia.
I believe NHS England should call a halt on this. It would do better to spend the money on social care for patients with dementia because that is where the problem lies, not in making the diagnosis.
Dr Stephanie de Giorgio is a GP in Deal, Kent