Looking at the proposal to pay GP’s £55 for every dementia diagnosis they make seems to lead to a conflict of interest.

http://www.bbc.co.uk/news/health-29718618

Wouldn’t it be better to pay them ‘per head’ to annually assess all patients over a certain age and refer those they had concerns about?

Interestingly, they do just that….
Don’t take everything you see in the press as gospel or wholly true..

DrP

As I undrstand it, docs / trusts already get paid in a similar way for all sorts of outcomes. From stepping into a hospital, to enrolling someone on a quit smoking programme, they get a fee.
On top of which you can earn more in certain posts – a fellow mtb rider on his A&E rotation used to sign death certificates and reports for insurance as a way of buying a new bike as med student.

So if you’d still get the money if diagnosis rates stayed the same but the assessment process was all in place?

Or is the ‘payment on diagnosis’ bit really saying ‘payment for finding a higher percentage of cases in the target group’ and you have to find more cases to get the cash?

Can you make a meaningful dementia diagnosis in primary care? Or is this just the payment for referral to a dementia specialist and subsequent confirmed diagnosis?

I wonder how well hospital services are being supported to see any extra suspected cases in a timely way?

I think the key thing here is (no disrespect to anyone) – most people really don’t realise how GPs/primary care/hospitals are actually funded – where the income streams come from.
Some is from standard contract.
Some is from private work (hey – pay me enough and I’ll wash your car for you)
Some is from additional services you can opt in/out of.

Like the dementia one – I don’t HAVE to do it, and often if the work involved isn’t financially worth it, practices will opt out.
The link i posted is (I believe – even I’m not 100% sure on some things) a DIFFERENT scheme to the £55 per diagnosis. THis is for “encouragement to identify memory problems in at risk groups”, and if you find an issue, taking it further.
It’s because most people aren’t openly ‘open’ about some issues, so the health service is encouraged to ask about them.
Really, I think we get paid a few quid for asking and for going on to further tests if necessary.
Not much, but in light of our funding from other areas (see above…) being cut bit by bit, we have to take all we can to keep our staff employed!!

DrP

Probably explains why my GP has diagnosed me with COPD, which I only found out about because a nurse mentioned it. Asked for it to be removed from my records and they refused instead sending to the hospital for various breathing and lung function tests. All tests passed and returning to the senior doctor at the practice and he still wouldn’t remove it saying I had to lose some weight (doctor is the same size as me) and he would reassess it then. No alternative practice to go to so stuck with false entries on my record.
Any GP’s on here I would like some advice on how to proceed with this as it is on my record and invalidates any life, health and travel insurance unless I declare it which bumps up the premium.

The GP contract is phenomenally arcane and complex – but by linking processes and outcomes directly to financial reward, you could argue that it works better than funding everything centrally, putting docs on a salary, and setting them targets in specific disease areas. That doesn’t sit well with people who say that incentivised privatisation is bad for the NHS, though.

I worked briefly for ‘Doctor’ magazine, and had hoped never to see the term ‘Read Code’ again. 😀

Can you make a meaningful dementia diagnosis in primary care?

Ideally one should refer to the memory service, but essentially, YES, GPs can diagnose dementia if need be.

I wonder how well hospital services are being supported to see any extra suspected cases in a timely way?

This is the joke – for a stretched service, HUNTING for extra cases despite the clinical good a diagnosis can offer, just doesn’t make sense! Our memory service is really over run as it is!

DrP

The basic premise is that dementia is under-diagnosed when GPs / patients and families know it’s there as there is a stigma involved and a (mis)belief that there’s nothing much that can be done.
Without a diagnosis a patient and family can not access many services – this didn’t used to matter much as these services did not exist, but they do now so these patients and their families/carers are missing out.

So, it’s not about getting GPs to assess more people – they tend to know who these people are – it is about officially labeling the illness so people can access care.

And as DrP says, GPs are paid to do all kinds of things: per vaccination, per annual review… This is just the first time they’ll be paid for a diagnosis but that’s because dementia differs from other diagnoses – most other things no-one minds the actual diagnostic label.

That’s the rationale behind it. There are of course pros and cons of such a thing…

This is the joke – for a stretched service, HUNTING for extra cases despite the clinical good a diagnosis can offer, just doesn’t make sense! Our memory service is really over run as it is!

Presumably unless the patient can access these services to refine the diagnosis between different types of dementia, it’s hard for you to prescribe anything, so it’s just a broad label.

often if the work involved isn’t financially worth it, practices will opt out.

THANKS

Not a personal dig but I hope you get the point being made

^^
Not really, no.
Care to elaborate?

TO explain a bit more – If the ‘local NHS’ suggests to me that by my practice monitoring a patient weekly for ‘serum rhubarb levels’ rather than the local hospital, they’ll fund it by 50p per patient per year, that is a no brainer – it would cost more in staff time and premesis factors, and as such I’d say “No thanks, carry on as is”. If they paid £8 per blood test, on a weekly basis, it WOULD be financially worthwhile.

I think your comment, though well meaning (You imagined me turning away a sick child because it’s too ‘costly’, I suppose?), kind of shown the (expected, from a layman) lack of understanding of the work/funding involved in the NHS. Soooo much of what I get asked to to is clerical, not clinical, and as in the point I just made, if it’s going to cost my business (a business that needs to run for the benefit of the local community’s health) money, rather than make money, then like any business – i’ll consider the implications and turn it down.
Actually, I do a lot of ‘stuff’ for free or at a cost to me, because it’s the right thing to do. We’re not all heartless y’know..

DrP

Does ‘ash cash’ lead to increased mortality rates? 🙂

(ok, we’ll try and remove Shipman from that as a bit of a one off)

ninfan – no ,everyone still dies once…

and to be honest the forms and need to contact and speak to relatives to discuss, and other Drs to do the 1st/2nd part, liaising with coroner’s officers if there is one of a whole long list of circumstances, travelling to a mortuary to see the body etc etc, mean that it isn’t financially worth it… I’d be very happy if we didn’t have to do it.

some nice accurate responses above from primary care. I’d agree with Dr P and others above

Presumably unless the patient can access these services to refine the diagnosis between different types of dementia, it’s hard for you to prescribe anything, so it’s just a broad label.

The important thing here isn’t TREATMENT for dementia – but support.
There are strict criteria for receiving tablet treatment, but anyone with dementia should have access to support and carers.

This is the key – if I label someone with dementia then they can access this help. If I don’t, they cant (The system really is that pedantic!)

DrP

I suppose it stops the kids getting the house transferred into their names!

It is shame we have to pay Doctors to do certain things as when you incentivise things you get a change in behaviour.
Folk are motivated by money, even Doctors, so we will get more diagnosed.

I realise you[ the profession] have not chosen to do this but I would prefer you were left to do your job rather than paid to deliver certain diagnosis.

I was rushing when I typed it hence brevity and i mean it not as a dig at you or the profession. I am rushing now as well so hope this was clear

OP, a good thread and indeed it highlights some of the issues which I too think are a conflict of interest. Dr’s get paid for example for giving immunisations (like MMR) when the government has a drive/target. So when you get that advice that “it’s safe” there will be an element of medical advice and a tinge of financial incentive.

@JY here is another topic we agree on !

EDIT: BTW I have seen bizarre behaviour elsewhere, in the USA seeing the doctor costs (say) $50 but if they give you a prescription you can claim all of it back from the insurance company versus if the doc says “you’re fine, just rest up” you are $50 out of pocket.

I realise you[ the profession] have not chosen to do this but I would prefer you were left to do your job rather than paid to deliver certain diagnosis.

I completely agree!
I was chatting with my partner – we both agree this is, for want of a better word – annoying!!
It seems to ‘cheapen’ the work we are currently doing in ‘encouraging’ patients to come forwards if they think they might have memory concerns.
In all fairness, I’ve yet to pick up a new dementia case in my questioning, but now all i see this doing is making the patient think “he’s only after 55 quid” and are unlikely to be ‘on my side’ in the matter!

I’d be more respected and probably better off if this WASN’T offered!

No one asked for it!

DrP