Sunday, 1 March 2015

Patients wrongly told they may have dementia

Patients wrongly told they may have dementia by GPs on a controversial £55 bonus scheme, researchers warn

  • Initiative was launched by the NHS to boost shockingly low detection rates
  • But leading doctors and campaigners branded it ‘unethical’
  • They warned patients would be wrongly labelled as having dementia
A controversial scheme to pay GPs £55 for every new case of dementia on their books is leading to patients being wrongly told they may have the devastating illness, researchers warn.
The initiative was launched by the NHS in the autumn to boost shockingly low detection rates and meet ambitious targets.
Leading doctors and campaigners branded it ‘unethical’ and warned patients would be wrongly labelled as having dementia.
Now researchers at the University of Sheffield say there is evidence these concerns have been realised.
Researchers have warned that a controversial scheme to pay GPs £55 for every new case of dementia on their books is leading to patients being wrongly diagnosed. Stock photo
They have found that the number of ‘inaccurate’ referrals by GPs to memory clinics – centres to diagnose dementia – has doubled since the scheme was introduced. 
A study of 150 patients found that just over half – 52 per cent – who had been sent to memory clinics for scans since October were later found not to have dementia. This compares to rates of between 25 and 30 per cent before the scheme was introduced.
Many had temporary memory problems brought on by depression or old age rather than dementia.
Lead researcher Dr Daniel Blackburn, consultant neurologist at the University of Sheffield, said the initiative may be having a ‘devastating consequence’ on patients and families.
GPs can either make a diagnosis themselves following a series of detailed questions or send patients to memory clinics for scans. But neither system is accurate so it follows that as more patients are sent for tests, the higher the chance of more people being misdiagnosed.
Researchers are also concerned that as GPs refer more patients to memory clinics, waiting times increase ever further for those who genuinely do have the illness and need treatment.
There is absolutely no evidence to suggest the £55 scheme is leading to patients being wrongly diagnosed by GPs
Professor Alistair Burns, NHS England
Dr Blackburn, whose study was uncovered by Pulse magazine, said: ‘We already know there are long waiting lists to be seen and if you send more people who don’t have dementia into those clinics … it slows down the process.
‘But also I think there is a risk that if we don’t analyse patients carefully enough then we are going to give people a false diagnosis.’ 
Meanwhile Dr Martin Brunet, a GP in Guildford, Surrey, said there was ‘no way of knowing if doctors have gamed the system’.
He added: ‘Consider also that someone might have dementia, but the GP knows the memory clinic won’t turn them around before the end of March.
‘What would you do in that situation? Tell yourself that’s bad luck that the memory clinic has such a long waiting list in your area, or code them as dementia now, knowing that after the end of March you can always change the code if the specialist diagnoses something else.’ 
Figures show that the number of patients diagnosed with dementia has increased seven-fold since the scheme was introduced.
There were nearly 35,000 recorded cases in the five months since October 2014 compared to 4,600 between April and September 2014. 
A study of 150 patients found that just over half who had been sent to memory clinics for scans since October were later found not to have dementia. Stock photo

Currently, around 850,000 adults in Britain have dementia but only 45 per cent have been formally diagnosed with the illness.
NHS England say the scheme is only a temporary measure to improve detection rates and will stop after the end of March. 
Professor Alistair Burns, NHS England's national clinical director for dementia, said: 'High quality, accurate and timely diagnosis of dementia allows people to access the emotional, practical and financial support they need.
'There is absolutely no evidence to suggest the £55 scheme is leading to patients being wrongly diagnosed by GPs. 
'The small study of patients visiting a memory clinic in Sheffield in 2012/13 was carried out long before the introduction of the temporary £55 financial incentive for GPs, launched in late 2014. 
'It is highly unlikely a patient would be told they have dementia if the GP was not certain - if there is any doubt, the patient will be referred for a further assessment to determine the diagnosis, as is clearly happening in Sheffield.' 
Last week it emerged that GPs could win bonuses for prescribing fewer antibiotics. Health bosses fear the drugs are being handed out so freely that they are losing their effectiveness and they claim cash incentives will help curb their use.
 
 

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