Fury at GPs’ ‘bounty’ for dementia diagnosis

Global problem: David Cameron says the world needs to take ‘immediate action’ on dementia © PA

Over half the dementia cases in Britain are going undiagnosed, it is believed, so the NHS has introduced a cash reward system for doctors. But will it undermine patients’ trust in their GPs?

It is ‘odious’ and an ‘ethical travesty’ that shows ‘either a lack of moral insight, or a failure of moral leadership,’ according to the former boss of one of the UK’s top medical groups. His fury is not directed at any reduction in NHS services, but a new scheme intended to help dementia sufferers.

NHS England is under fire after it revealed a new system to pay GP practices £55 each time they diagnose a patient with dementia. The aim is to ‘reward GP practices for undertaking a proactive approach’ and to give them an incentive to make more diagnoses.

Fewer than half of the UK’s 800,000 estimated dementia sufferers have had their condition diagnosed, which health secretary Jeremy Hunt says is a ‘national shame’. The scheme is part of a drive to have two thirds of cases diagnosed by 2015.

Dementia is an umbrella term for a group of diseases such as Alzheimer’s which are caused by protein build-ups in the brain and affect functions like memory and language skill. Sufferers often struggle with everyday tasks, and some forget aspects of their life and even who their loved ones are. It is a harrowing illness, for sufferers, friends and family alike.

One in three Britons over the age of 65 are predicted to develop dementia by the time they die, while eight out of ten people in care homes are already suffering severe memory loss. It poses a major threat to our ageing society, and by 2018, the UK alone will face dementia costs of £27 billion every year. The number of people affected globally, which currently stands at over 35 million, is set to double every 20 years.

While there is no cure, an early diagnosis allows people to make appropriate changes in their life, gives families time to prepare and sufferers time to access support.

Tough choices

The Patients Association says the incentive scheme is a ‘step too far’ and will put a ‘bounty on the head’ of some patients as doctors prioritise money over healthcare. While the money goes to GP practices and not directly to doctors, the impression that GPs are making money from misery will damage the doctor-patient relationship. It also rewards clinics that have neglected dementia diagnosis before, whereas clinics that have been diligent will receive nothing.

Yet supporters point out that most GP clinics already receive incentives for diagnosing problems like high cholesterol, blood pressure and diabetes, and this scheme simply brings dementia into line. Testing for illnesses costs GP practices money, but this scheme makes the expense less of an issue. The NHS would soon identify any doctor who misdiagnosed for financial gain. We should welcome anything that helps to identify those suffering with this awful illness.

You Decide

  1. Is this incentive scheme a good idea?
  2. Is dementia the most frightening illness?

Activities

  1. Make a poster arguing either that paying doctors to make diagnoses is ethically wrong or that it is practical and a good idea.
  2. Using the links in ‘Become an expert’, research dementia and degenerative illnesses. Make a presentation on it for your classmates.

Some People Say...

“We should place far more trust in our doctors.”

What do you think?

Q & A

Does dementia only affect older people?
Mostly, but there are currently more than 17,000 people under 65 with dementia in the UK. Thanks to better health care and diet, humans are living longer, but this means that we are more at risk of illnesses like dementia. It is likely that significant advances in treatment will be made by the time most of us reach our 60s, but dementia will affect tens of millions before then.
Why haven’t we found a cure?
Scientists still do not fully understand dementia as it seems to be caused by a complex mix of genetics, lifestyle and environmental influences. It is also difficult to develop a drug that targets just protein build-ups in the brain. Yet a trial on mice has offered some hope of a cure - read our piece linked in ‘Become an expert’ for more information.

Word Watch

Groups
The comments come from Dr Martin Brunet, the former head of the Royal College of GPs, a network of more than 42,000 UK doctors.
GP
While some doctors specialise in a particular branch of medicine, General Practitioners have a broad range of knowledge and are a patient’s first port of call when getting medical advice.
Alzheimer’s
Alzheimer’s is a physical disease affecting the brain, causing protein ‘plaques’ and ‘tangles’ develop in the structure of the brain, leading to the death of brain cells. Over the course of the disease, the condition worsens. It is the main cause of dementia.
Globally
While dementia is set to become even more of a problem across the world, Alzheimer’s Disease International says that only 13 of 190 countries in the World Health Organisation have national dementia plans in place.
Costs
Many GPs are self-employed and are paid according to what services they provide and the way they choose to provide their service. Salaried GPs typically earn between £50,000 and £80,000 a year.

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