Doctors demand end to 'cash for dementia diagnoses'

More than 50 doctors have called on the head of the NHS to withdraw a scheme which pays GPs £55 for every patient diagnosed with dementia

Doctors are calling for the immediate suspension of a national scheme which pays GPs £55 a head for every patient diagnosed with dementia.

More than 50 doctors have written an open letter to the head of the NHS demanding the axing of the new “cash for diagnoses” system brought in last month, which was revealed by The Telegraph.

The letter, published in today’s British Medical Journal, says that giving GPs financial rewards for diagnosing patients sets a “dangerous precedent” which could break the trust between patient and doctor.

Warning that such incentives could have “truly tragic consequences” - in encouraging family doctors to make incorrect diagnoses - they call for it to be withdrawn without delay.

It comes as doctors in Kent and Buckinghamshire drew up plans to donate any payments they receive under the scheme to a local dementia day centre, in protest.

The initiative by NHS England follows pledges by ministers to dramatically improve rates of dementia diagnosis, with just half of sufferers currently diagnosed.

The Government has set a target for two thirds of sufferers to be diagnosed by March.

Under the new scheme, doctors will receive £55 for every extra patient who receives a diagnosis in the six months leading up to the deadline.

Local schemes have gone further, with doctors in Bristol offered up to £200 per diagnosis.

Although GPs are already financially rewarded for carrying out medical checks, this is understood to be the first time they have been given financial rewards in return for making a diagnosis. When news of the scheme emerged last month, some condemned it as "an ethical travesty".

More than 50 GPs, dementia experts and patients groups, led by Dr Martin Brunet, a GP from Guildford, have signed the letter to Simon Stevens, NHS chief executive, and Alistair Burns, National Clinical Lead for Dementia.

In it, they say the scheme has “crossed a line that should never be crossed” which could leave vulnerable patients fearing they are being given a devastating diagnosis simply so their GP can line his pockets.

“The diagnostic process is unique in the doctor-patient relationship because the patient has to trust the doctor’s judgement,” they write.

“There must, therefore, be absolute surety that the doctor has no other motivation than the patient’s best interests when they make a diagnosis.”

The doctors say that the difficulties of correctly diagnosing dementia, there is a “very real possibility” of patients without the condition being wrongly labelled, because of the financial incentives for GPs.

“To be given a diagnosis of dementia is challenging when the diagnosis is correct, but to receive such a label incorrectly can have truly tragic consequences,” the doctors say.

Dr Brunet told The Telegraph: “What has really struck me is the strength of feeling not just from GPs but also from patients about this – there is really deep concern over this, especially about what it could do about the trust between doctor and patient.”

The letter is also signed by Katherine Murphy, chief executive of the Patients Association, who said that it was wrong to “put a bounty on the head” of the vulnerable.

The Cedars Practice in Deal, in Kent, has drawn up plans to send all funds they receive to a local dementia centre, in protest at the ethics of it. GPs in Buckingham are discussing similar ideas.

Earlier this week, health officials announced plans to offer people aged between 40 and 74 screening for their risk of dementia, and tell them how their "brain age" compares to their biological age.

Dr Martin McShane, National Clinical Director for people with long-term-conditions said: “Dementia is an absolutely devastating condition, and there are too many people undiagnosed who are being denied the care they need. As the population ages, we cannot tinker at the edges. We need to make a fundamental breakthrough, a step change."

He added: "Our aim is that every patient with dementia gets the best treatment and the right support as early as possible. To achieve this, we need both GPs and the public to be on the alert, spot the signs early and either seek help or get patients the help they need.”

* Experts are calling for new targets to reduce levels of antibiotic prescribing. A summit on antimicrobial resistance in London yesterday heard warnings that resistance to antibiotics has become “one of the major health challenges of our age”. Royal Colleges representing GPs, nurses, and public health doctors called for targets to reduce levels of antibiotics consumption - now rising by 6 per cent a year – to the levels reached in 2010
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