26th November 2014
Previously reported in PS magazine, the bonus scheme delivering £55 to GPs correctly diagnosing dementia, is to be dropped from April 2015. NHS England Chief Executive Mr Simon Stevens remarked upon the ‘unusual’ questions over any potential renewal of the programme – intended to be a “one-time catch up opportunity.”
The programme, which pays practices a small fee for each additional dementia diagnosis if they show a net increase on the practice register from October to the end of March 2015, is an attempt by the Government to hit diagnosis targets. It has been ultimately condemned by GPs for being unethical.
Though Mr Stevens is adamant in repealing the deal, he declines to admit regrets in rolling it out. “I think it’s too early for hindsight. We need to look at the dementia diagnosis rate through the year before we do that. It is not driven by patient preference, but by different levels of focus on this topic. If people don’t want to take the payment that’s entirely legitimate. The underlying point though is you have a lot of variation in your chance as a patient with early stage dementia in having that identified and get the support, whether that is medicine or a care plan. There are quite a lot of people who are not having the opportunity to get that early information and support. So there’s a whole range of things being done to address that, and this is only a small part.”
In opposition to the policy, GPC deputy chair Dr Richard Vautrey remarked that “decisions about an individual’s care should always be based on clinical need, not financial imperatives, and while the diagnosis of dementia is important it should not be done in a way that could seriously undermine the doctor/patient relationship. Rather than wasting money on short-term, pre-election targets, it would be far more beneficial to invest properly in GP services so that GPs can provide holistic or to provide proper resource to meet the real needs that patients and their carers tell us are crucial...”
Widely criticised by GPs, an open letter was written to Mr Stevens at NHS England and National Clinical Director for dementia Prof Alistairs Burns, calling for the policy to be withdrawn. Issues surrounding the undermining of ‘trust inherent in the doctor-patient relationship’ were rife and cited the public’s reaction as evidence of its ethical concerns.