Front-line medical staff should be able to recognise very common conditions, such as dementia. But with an estimated 60% of people with dementia going undiagnosed, a six-month, £5m scheme is now being set up in an effort to increase the number of people receiving treatment. Under the scheme, GPs are to be paid £55 for each case of dementia they diagnose.
NHS England, which announced the fund, want two-thirds of people with dementia identified and supported by 2015. But giving payments to GPs raises questions about why more diagnoses aren’t already being made by some family doctors and why there needs to be a financial incentive to do so.
Are some GPs unable to diagnose dementia because they have inadequate diagnostic skills, or unwilling to diagnose it because it will cost them something – perhaps money out of their budgets, or an increased workload?
We know that skills can vary between GPs. In 2010, a King’s Fund study concluded that there was a variation in the quality of diagnosis. This related mostly to cancer, not dementia, but if the £55 is to cover a lack of skills then the money could of course go towards training. But if it’s because GPs are unwilling because of some kind of financial loss, then it really is a question of ethics.
The ethical point is that surely doctors diagnose illness in order to benefit their patients, not themselves. They should not need any motivation other than professionalism to spot which of their patients are developing, or at risk of developing, dementia.
Nevertheless, the experience of the introduction of the new GP contract in 2004 – the deal made between the government and family doctors – shows that financial incentives are very effective in changing GPs’ practice.
GPs fought against the new contract, but once it was introduced they implemented its quality and outcomes framework so efficiently that the government had to pay them much more than expected at the end of the first year of operation because they hit all their performance-related targets. This should not have been surprising: doctors are smart and rational people, who will, like the rest of us, act so as to maximise their incomes when offered an opportunity.
So is the reason for the £55 that GPs need further training in dementia diagnosis and this will pay for it? The government certainly ought to pay them to keep their skills up to date. But it seems an odd way to bring this about.
Or is the point that an increased number of dementia diagnoses will require the GPs who make them to provide more treatment and services – and they don’t think they can do this with their current funding? In which case, it’s the treatment that should be paid for, not the diagnosis. It is also generally unclear where this £55 figure comes from and it would be good to know how it was arrived at.
If there are question marks over the diagnostic skills of GPs, we should probably not expect the medical authorities to admit this. But it would be good to know more. However, what we should expect – and which would ultimately the best outcome all around – is significant increases in diagnoses of dementia.