Dr Iona Heath, former president of the Royal College of GPs has called the proposal that GPs receive £55 for each patient dementia diagnosis an ‘intellectual and ethical travesty’.
And Dr Martin, Brunet, a GP from Guildford, Surrey, said it creates a major conflict of interests that is unethical, because the payment is not on the basis of caring for patients, but only the diagnostic label doctors apply.
Other doctors say that the money would be better spent providing the right amount of support for people already coping with the disease.
Dementia UK points out that GP’s do not need a financial incentive to make a diagnosis, but many good doctors are hesitant because of the dearth of follow-up care.
A statement on the organisation’s website says, ‘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.’
NHS chief executive Simon Stevens announced the incentive scheme, where GPs across England are to be offered a £55 bonus for each patient diagnosed with dementia, at the annual Royal College of General Practitioners’ conference in Liverpool.The plan will run until the end of March 2015, and practices wishing to participate must sign up by 17 November 2014.
GPC (General Practitioners’ Committee) deputy chairman Dr Richard Vautrey said the push was ignoring patients’ and carers’ real needs.
He said, ‘I think the key focus for NHS England should be providing and ensuring better services for patients that actually have dementia. That’s the area GPs are most concerned about: ensuring that patients and carers get the right amount of support and that’s something that’s often lacking. That’s where there’s a real need for improvement.’
George McNamara, of the Alzheimer’s Society, said, ‘We know some doctors are reluctant to give a diagnosis because they know the right help and support isn’t available locally.’
Misdiagnosing patients
Dr Martin Brunet, a GP from Guildford, Surrey, said it could potentially lead to doctors misdiagnosing patients. He also warned it may result in patients with very unlikely symptoms and their families having to go through the ordeal of rounds of dementia screening just in case.
He said, ‘We need to think very carefully about this as it crosses a line that has not been crossed before – the direct payment on the basis of making a diagnosis – ‘cash for diagnoses’.
‘Patients are at their most vulnerable when we make a diagnosis, because it is the doctor’s judgment and so very difficult for the patient to challenge it.’
How can a diagnosis said to be in patients’ and caregivers best interests when care and support is clearly inadequate?
At a national conference in September, Health Minister Jeremy Hunt Jeremy Hunt called for a “revolution in out of hospital care” to give more help and support to sufferers, and for early diagnosis. He said then that Britain needed a revolution in ‘out of hospital care – that is, social care, to give more help and support to sufferers.
Also, there’s the question of patients’ choice: it’s their human right to choose whether or not they want to know, or not. A diagnosis of dementia can be devastating, especially to frail older people who live alone, and who may not have the resilience to cope with it. And who, more importantly, could not get appropriate care and support. According to Age UK, 900,000 older people are already facing ‘catastrophe’ because they cannot obtain care.
Wessex LMC’s (Local Medical Committee’s) chief executive Dr Nigel Watson said the scheme was ‘politically driven’ rather than to the benefit of patient care.
So what’s behind the political drive? Could it possibly be to create a market to incentive pharmaceutical companies’ research? If that’s the case, would this mean sacrificing thousands of older people by throwing them into the ‘diagnosed’ pot, knowing that care is not available for them?
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