Is It Right That GPs Should Be Paid for Diagnosing Dementia in Patients?

The Background

It was announced yesterday by NHS England, Wednesday 22 October 2014, that GPs will receive a payment of £55 for each patient that they diagnose with dementia. To say the least, this proposal has prompted a good deal of debate. It has its supporters and its detractors.

The statistics on dementia are stark. The following are provided by the Alzheimer’s Society:

1. By 2015 there will be 850,000 people with dementia in the UK.
2. There are 40,000 younger people with dementia in the UK.
3. There are 25,000 people with dementia from black and minority ethnic groups in the UK.
4. There will be 1 million people with dementia in the UK by 2025.
5. Two thirds of people with dementia are women.
6. The proportion of people with dementia doubles for every five-year age group.
7. One in six people aged 80 and over have dementia.
8. 60,000 deaths a year are directly attributable to dementia.
9. Delaying the onset of dementia by five years would reduce deaths directly attributable to dementia by 30,000 a year.
10. The financial cost of dementia to the UK is £26 billion per annum.
11. There are 670,000 carers of people with dementia in the UK.
12. Family carers of people with dementia save the UK £11 billion a year.
13. 80 per cent of people living in care homes have a form of dementia or severe memory problems.
14. Two thirds of people with dementia live in the community while one third live in a care home.

The NHS England initiative is motivated in no small part by the further statistic that estimates that less than half of people in the UK who have dementia receive a diagnosis. That’s something like 400 000 people who have dementia but have not been diagnosed.

Let’s have a look at the arguments for and against GPs receiving payments for dementia diagnoses.

The Case for Payments Being Made

1.      It is nothing short of a scandal that less than half of those with dementia receive a formal diagnosis. This is the view of Jeremy Hughes, the Chief Executive of the Alzheimer’s Society.

2.      Incentives for GPs work, something that has repeatedly been demonstrated since the introduction of new contracts in 2004.

3.      Doing nothing is not an option. Too many people without a diagnosis are left without the support they badly need.

4.      The payment is not just a payment for a diagnosis. GPs will need to have a plan and show improving rates of diagnosis.

5.      Patients who receive a diagnosis are in a position to access treatment and plan their lives.

6.      Improved diagnosis rates may lead to improved research into dementia treatments.

The Case against Payments Being Made

1.      A payment for a diagnosis is a “bounty on the heads” of certain patients. This is the view of Katherine Murphy, the Chief Executive of the Patients Association.

2.      Good GPs already diagnose dementia without an added incentive.

3.      Do GPs fail to diagnose not because they can’t diagnose dementia but because:

a.       Each diagnosis is a cost to the practice

b.      Each diagnosis adds to GPs workload

c.       GPs fatalistically believe that a diagnosis leads to nothing being done

Each of the above is unethical and should not lead to GPs being rewarded to change their practice.

4.      Money is needed not so much for diagnosis, which doctors are able to do, but for treatment and support following diagnosis.

5.      Any money available would be better spent on research to improve the treatment and care of patients.

6.      If it is the case that GPs cannot diagnose dementia because they lack the diagnostic skills, the payment will do nothing to improve their skills.

7.      Incentive payments to make a diagnosis may lead to GPs erring on the side of a diagnosis. 

Conclusion

I do not for a moment suggest that the above points, for and against, represent the arguments to exhaustion. They are, though, some of the main points that are put forward but each of the sides in this debate.  

On which side do you fall?

 

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.