The announcement that GPs in England will receive £55 for each patient they diagnose with dementia has been criticised by the Patients Association and the British Medical Association. Paying doctors per dementia diagnosis does not seem like money well spent, and is flawed in many ways.
The national commissioning board, NHS England, wants two-thirds of the estimated number of people with dementia in England to have a diagnosis by 2015. And for the past year, diagnosis rates for local areas have been made public online by the Department of Health.
NHS England has confirmed that the figures are based on the 2007 Dementia UK report, produced by the Alzheimer’s Society, rather than the most up-to-date dementia prevalence estimates made available by the charity in September 2014. The new consensus estimates are slightly lower for the 80–89 years age group and slightly higher for the 65–69 years and the over-90s age groups.
The new payment — part of a six-month opt-in service overseen by NHS England — adds a financial incentive to the pressure already placed on doctors by clinical commissioning groups to improve their diagnosis rates. Incentives within healthcare are not new; quality and outcomes framework (QOF) indicators have formed the basis for GP remuneration in the UK for a decade. But having a payment linked to each diagnosis places doctors in a quandary, especially when making a diagnosis based on a borderline condition.
A diagnosis of dementia is a life-changing event for patients and their carers. A correct diagnosis could mean access to appropriate treatment and practical support. But an incorrect decision could mean avoidable distress and no added benefit for the individual.
It is concerning that even the most conscientious GPs might be influenced to categorise patients with some degree of cognitive decline as having dementia when their condition might be transient or not progress to dementia. Assessing cognitive impairment is complex and, of all the factors a doctor needs to consider to make a diagnosis of dementia, a ‘finder’s fee’ should not be one of them. GPs ought to send a clear signal to the government by not taking up the voluntary scheme.
Moreover, it does not make much sense for the government to boost dementia diagnosis rates when so much needs to be done to ensure appropriate levels of care for those who are known to have the condition. Addressing the inappropriate prescribing of antipsychotics, anxiolytics and sedative antidepressants is just one example of where investment might be justified.
This new incentive scheme should be stopped.