Dementia and GP payments - what's the truth?
Another day of banner headlines about GPs, for all the wrong reasons. The news that GPs are to be offered a payment of £55 for every diagnosis of dementia they make has met with criticism from many quarters. The Patients Association has said the plan is 'a step too far - putting a bounty on the head of certain patients'.
The first thought that crossed my mind was that nobody had mentioned all the patients who needed screening in order to make one diagnosis. Even if we just screen people with obvious risk factors for dementia we would probably need to set aside time to screen 10 patients for every patient found to have dementia. In fact, NHS England has made it clear that the money is not for the diagnosis - it's for setting up a screening service so that we can pick up early symptoms which patients wouldn't tell their GP about otherwise.
Screening for dementia takes time - apart from the questions we need to ask, we need to look out for all the other factors that might affect memory. These range from medications to depression to physical conditions like underactive thyroid.
I was stunned at the suggestion in one of the interviews I did on the subject today that doctors might diagnose people incorrectly with dementia just to get the £55 payment. The work involved in following up someone diagnosed with dementia and organising services for them is huge. If any doctor were cynical enough to think about making a diagnosis just for the money (and call me naïve but I don't believe there are), they would certainly have done the maths and realised it wasn't worth the work.
The whole reason for doing all the screening we already do (for high cholesterol, high blood pressure, diabetes etc.) is because making a diagnosis at an early stage can prevent complications. Until a few years ago, there were no medications which could help delay the progression of dementia. Even today, the medications we have aren't suitable for everyone. Lifestyle changes like stopping smoking can certainly help with some forms of dementia, such as 'vascular dementia'. But the vast majority of GPs are encouraging healthy lifestyle changes for their patients anyway. The whole point of making a diagnosis is to use the diagnosis to help the patient. Otherwise we're just making matters worse by giving them potentially devastating news and leaving them to imagine the worst with no hope.
There is no point in making a diagnosis of dementia if we can't offer support and follow-up that makes a difference. NHS England has made a pledge to diagnose two thirds of the estimated 400,000 people in the UK who have dementia but don't yet have a diagnosis by 2015. But it has also promised to provide them with high-quality support after they have the diagnosis. Many of those services aren't about direct healthcare, but social services support to help keep them independent. Day care centres, benefits advisors, occupational health adaptations at home and advice on legal issues can all make a difference.
It's also hugely important to have plans in place in advance to reduce the risk of vulnerable people with dementia ending up in crisis. And that's before we even start thinking about the hundreds of thousands of heroic unpaid carers looking after dementia sufferers, and what they need. Financial support for carers may help, but they also need respite and practical help.
So should the story be about a '£55 bounty'? From where I'm sitting, after 25 years as a GP, I would say that the real story is getting people with dementia the help they do desperately need.