NHS dementia plan to give GPs cash for diagnoses criticised as ‘ethical travesty’

http://www.theguardian.com/society/2014/oct/22/nhs-dementia-diagnoses-gps-patients-criticised

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The NHS is under fire for paying GPs to diagnose dementia by giving them £55 each time they identify the disease in a patient. The payments scheme, which NHS England has introduced to increase woefully low levels of dementia diagnosis, has been condemned as “odious” and “an intellectual and ethical travesty”.

The organisation is offering to give GP surgeries £55 for every patient on their list who has been diagnosed with dementia in the six months up to next March, as part of a drive to get the rate of diagnosis up from about 50% to two-thirds of all those who develop the condition.

Critics claim the fees risk undermining the bond of trust between doctors and patients by giving GPs for the first time a financial incentive to diagnose a specific condition. Doctors and patient groups denounced the scheme after Dr Martin Brunet, a GP in Guildford, Surrey, revealed its existence in an article he wrote for the medical website Pulse.

“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 [direct enhanced service], so that it can hit its target to raise diagnosis rates,” he wrote.

While nobody opposed the correct diagnosis of dementia , Brunet said, “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.”

The scheme’s “bullying of the doctor-patient relationship” showed NHS leaders “really have gone too far. NHS England has crossed a line that has not been crossed before.” Although GPs are already paid for conducting asthma reviews and getting patients with high cholesterol counts on to statins, they are not rewarded for identifying any particular condition.

“There must be absolute trust that the doctor is acting only and solely in the best interests of the patient,” Brunet said. “To contaminate this process with a financial payment seriously undermines the doctor-patient relationship in a new and pernicious way.”

He recommended that family doctors boycott “this odious scheme” and suggested GPs who accepted the £55 payments should tell patients.

Katherine Murphy, chief executive of the Patients Association, opposed the payments. “This 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,” she said.

The Royal College of GPs said the initiative was unfair because it would give GP practices with the lowest rates of diagnosis the most money. And the British Medical Association, the doctors’ union, said its was opposed to such incentives.

Jeremy Hunt, the health secretary, has condemned diagnosis rates of dementia, which were just 37% as recently as 2010, as shockingly low and “a national shame”. There are thought to be up to 400,000 people in England with dementia who have not been diagnosed.

NHS England said it was committed to better detection of dementia. A spokesperson said: “Dementia can be devastating both for individuals and their families. We know that more needs to be done across the health service to ensure that people living with dementia are identified so that they can get the tailored care and support they need. This additional investment is part of a drive to ensure this.”