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Cash for diagnoses? Just say no



The Government wants to bribe us to diagnose more people with dementia – to the tune of £55 per patient in the form of its new dementia DES, so that it can hit its target to raise diagnosis rates.

No-one is against correctly diagnosing dementia, but NHS England have either not considered the ethics of this new policy, or are so blinded by their goal that they don’t deem ethics to be important – either a lack of moral insight, or a failure of moral leadership.

To undertake the DES you would count how many patients with a dementia diagnosis on your register at the end of September, compare this with the number at the end of March and score £55 for every extra patient.

It’s that simple: no questions asked.

The profession can either roll over, take the cash and go back to worrying about all our other problems – or we can stand up to this bullying of the doctor-patient relationship, and tell our masters that this time they have gone too far. And they really have gone too far. NHS England has crossed a line that has not been crossed before.

We are used to being paid for things of course, like asthma reviews and statin prescribing, and we are well aware of the problems this causes – but at least patients can opt out if they don’t like it.

They can refuse to attend a review, decline our offer of a statin or politely take the pill packet and store it unopened in the kitchen cupboard. They cannot opt out of a diagnosis.

The point of making a diagnosis is something the doctor does alone. The patient can contribute, of course, they provide evidence and we certainly want to know what they think, but the moment of judgement is for the doctor and is enormously difficult for the patient to challenge. What we code in the notes really is up to us, which is why there must be absolute trust that the doctor is acting only and solely in the best interests of the patient.

To contaminate this process with a financial payment seriously undermines the doctor-patient relationship in a new and pernicious way.

If we sign up to this DES are we going to explain to our patients the profit we will make from diagnosing them? We would expect an insurance salesman to be transparent about the commission he would make if he sold us a policy – why would doctors be above the need for such transparency?

How will our patients feel if they knew? If you can look them in the eye and explain why you should be paid according to the diagnostic label you apply then go ahead and sign up – I for one could not do that.

And how will you feel about undiagnosing your patients if they’ve been misdiagnosed?

I’ve undiagnosed patients twice in the last year, and had to fight hard for a second opinion in one case when a trainee diagnosed dementia on the basis of an MRI scan alone without really talking to the patient.

Were I signed up it would cost me £55 a time to get these patients correctly diagnosed; might I hesitate if I knew that?

I am not naïve about the financial pressures we are under, but nor am I going to believe that we have no choice but to accept this. To find 10 new cases in the next six months would be some going – and it would only raise £550 in funding from the DES. If it’s money you’re worried about, surely we can afford to have a conscience in this case.

It’s time to say no, time to stand up for the doctor-patient relationship and the trust that it depends upon, and time to boycott this odious scheme, while screaming and shouting about it in the process.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.