Anger over 'cash for diagnoses' dementia plan in England

© Alamy

Ministers have pledged to dramatically improve rates of dementia diagnosis, which has led to the new scheme.

Family doctors will be paid £55 for every patient they diagnose with dementia under a new NHS England scheme which has been condemned as an "ethical travesty".

Leading GPs said the national project amounted to "cash for diagnoses" - allowing doctors to make a direct profit if they classify patients as suffering from dementia.

In some parts of the country, NHS authorities have gone still further - offering family doctors £200 for each new diagnosis made, The Telegraph can reveal.

Patients groups and doctors have condemned the schemes, saying they amounted to a "bounty on the head" of the most vulnerable, which could cloud the judgements of those making diagnoses.

Under the national scheme, doctors can receive the £55 payment for every extra patient given a diagnosis of dementia in the six months ending in March.

GPs qualify for payment if they diagnose the patients themselves - with no checks on whether their assessment is correct - or if they update their records when their patients receive a diagnosis in hospital.

Family doctors are already financially rewarded for carrying a host of medical checks, with a portion of their pay related to tasks such as taking blood pressure, measuring cholesterol and carrying out tests for conditions such as diabetes.

But the scheme is understood to be the first national initiative to offer doctors financial rewards for diagnosing patients with any condition.

It follows pledges by ministers to dramatically improve rates of dementia diagnosis.

In November, Jeremy Hunt, the Health Secretary, said it was a "national shame" that just half of those with conditions such as Alzheimer's disease are properly diagnosed. The Government has pledged to increase that figure to two thirds by March.

NHS officials said the national payments scheme, which has just been introduced, was part of efforts to "spearhead the NHS drive to identify people with dementia".

But leading doctors condemned the initiative, saying it was not ethical to offer GPs financial incentives which could sway them towards making a diagnosis, when cases were in doubt.

Dr Iona Heath, a north London GP and former president of the Royal College of GPs (RCGPs) described the national scheme as "an intellectual and ethical travesty."

Dr Martin Brunet, a GP in Godalming, Surrey, said any GPs who accepted the inducements ought to declare their conflict of interest before they declared a diagnosis.

He told magazine: "It crosses a line that has not been crossed before - the direct payment on the basis of making a diagnosis, or 'cash for diagnoses.'"

"The payment is not on the basis of caring for our patients, but only the diagnostic label we apply - this creates a major conflict of interests that is frankly unethical," he added.

The service - which is optional for GPs - pays them £55 for every extra patient on their "dementia register" when the numbers in March are compared with those on their lists last month.

Payments will be made for the net increase in the total number of patients with dementia, meaning that the £55 for each new case diagnosed will be "offset" against any deaths of those dementia register.

The payments have been introduced under a "dementia identification scheme" by NHS England.

A separate deal offered to GPs in Bristol by Bristol Clinical Commissioning Group offers an upfront payment of £500 for signing up to the dementia diagnosis scheme, plus £200 per newly diagnosed patient, with a £200 bonus if diagnosis rates rise by five per cent.

For the past two years, GPs have already been offered payments to carry out assessments for dementia.

Katherine Murphy, Chief Executive of the Patients Association, said the new move was "a step too far," and said doctors should never be offered financial inducements to make a diagnosis.

She said: "This is putting a bounty on the head of certain patients. Good GPs will be diagnosing their dementia patients already. This seems to be rewarding poor GPs. It is a distortion of good medical practice."

Mrs Murphy said there were problems with patients only going to their GPs when their dementia was advanced, but said the best way to tackle that was improving services, so they could be offered help.

Dr Maureen Baker, chairman of the RCGP, said the new schemes were not fair, because the greatest rewards would go to practices which currently have the lowest rates of diagnosis.

The British Medical Association said its negotiators for the current GP contract had opposed the introduction of such incentives.

Dr Richard Vautrey, deputy chair of the BMA's GPs committee said: "This is not a jointly negotiated enhanced service, it's something NHS England wanted to do. Practices will have to make their minds up as to how they will approach it and I'm sure they will have lots of issues with it. It's just until the end of the year, to see whether this particular scheme makes any difference to the variation in diagnosis rates."

He said the BMA believed the problem with dementia was not about diagnosis, but about providing patients with the condition with enough support.

A spokesperson for NHS England said: "Dementia can be devastating both for individuals and their families. We know that more needs to be done across the health service to ensure that people living with dementia are identified so that they can get the tailored care and support they need. This additional investment is part of a drive to ensure this."