So what do we think of this? Paying GPs to diagnose dementia

[jenniferpa]

http://www.theguardian.com/society/2014/oct/22/nhs-dementia-diagnoses-gps-patients-criticised

I'm in several minds. I'm all in favour of increasing diagnosis rates, but I'm not entirely happy that GPs are being paid, essentially, to do the job that they are already being paid for. But on the the other front: perhaps this will mean that for individual's fighting to get a diagnosis, such payments might mean that the possibility of dementia might be more at the front of a doctors mind.

On the whole, I doubt it will change good doctors practices but might encourage bad doctors to chase the money.

 

[lin1]

I am in two minds and feel much the same as you Jennifer.

 

[jenniferpa]

I don't know about two minds Lin - I think I'm in several minds about this. It seems like a not bad idea, and then you think about all the potential ramifications and go: whoa.

 

[Not so Rosy]

Unless a massive amount of new funding gets put in place, it all seems like lip service to me. So we diagnose you but there is ****** all help. More people chasing a small pot and very stretched services.

Two of the Care Homes Dad has been in this year have just been earmarked for closure by the County Council along with all the others they run.

 

[Pickles53]

Unless a massive amount of new funding gets put in place, it all seems like lip service to me. So we diagnose you but there is ****** all help. More people chasing a small pot and very stretched services.

Two of the Care Homes Dad has been in this year have just been earmarked for closure by the County Council along with all the others they run.

£55 x estimated 400,000 = £22,000,000. So I agree with you NotSoRosy, diagnosis without improved services is not a huge help.

There is a GP on breakfast TV right now saying the payment would be used to provide additional support by local practices. My mum's GP wrote one letter to the memory service and she never had any further contact with him even when diagnosis was confirmed six months later. Meanwhile the surgery caused two further problems with her regular medication and delay in diagnosing a UTI because they had not taken into account that she was a housebound patient with dementia who could not remember or follow instructions. I doubt that an extra £55 would have made a difference in either scenario.

 

[Grannie G]

I am shocked.

Considering the number of people predicted to develop dementia in the coming years, it would cost a fortune which would be better spent on help, support or research.

Doctors should not get bonuses for piecework.

 

[WILLIAMR]

There are some doctors who are after money but I think most act in the best interests of the patient.
I have very small cataracts in my eyes and I have mentioned to the doctor who checks me every year that I have private medical insurance. She checks me under the NHS annually.
She says she could remove them if I insist and take the money but they have not grown in 15 years and had they not been picked up by the optician I would have not known about them.
Her view is if the cataracts are not affecting my sight why risk an operation?.
I can see her point.

William

 

[stanleypj]

I agree that this is a very dubious idea.

And doesn't it just demonstrate that those who govern us assume that that all of us, including GPs are, like them, primarily driven by the desire to accumulate wealth?

 

[nicoise]

Hmmmm.... Two minds, certainly!

Trying to be positive, There might be a better service from GPs if they are more motivated to be involved in the whole story of support and information for the newly diagnosed person; but if it just remains as it is at present whereby a provisional diagnosis by a GP then triggers a referral to a consultant and then that is pretty much where it stops doesn't really improve the lot of the patient, or family trying to support them.

Getting a payment for bothering to do a memory test and some blood tests, which they should do anyway with someone presenting with symptoms, doesn't really help anyone other than the GP.

I'm not sure what difference this will make, and will it just increase the waiting times for an appointment with a consultant, scans etc which already exist - are there plans to improve the "next step" facilities?

A friend's father, presenting to a GP with some symptoms two years ago was told he had dementia; this has now been "downgraded" (my description) to an as yet unidentified neurological problem, but he (and his family) has had two years of great worry and sadness due to the diagnosis. The anomalies in his symptoms weren't investigated, but his lack of downward progression sparked off a little more effort finally.

As Jenniferpa has said, good GPs will carry on as before - but poor GPs will just get a bit more money for doing what they should do anyway.

 

[stanleypj]

A friend's father, presenting to a GP with some symptoms two years ago was told he had dementia; this has now been "downgraded" (my description) to an as yet unidentified neurological problem, but he (and his family) has had two years of great worry and sadness due to the diagnosis. The anomalies in his symptoms weren't investigated, but his lack of downward progression sparked off a little more effort finally.

This recent thread was about a misdiagnosis that also had serious consequences:

http://forum.alzheimers.org.uk/showthread.php?75872-Pensioner-Misdiagnosed

As you suggest nicoise, GPs can only really give a provisional diagnosis pending further investigation and given the state of some GPs' knowledge of the condition, some of them are clearly not up to doing that.

I agree that is there is a significant increase in GP referrals, there will be even more of a log-jam further up the chain.

 

[steviep]

A barmy idea in my opinion. Typical Tory Toffs rubbish. I think this will lose them a lot of votes in the coming election.

The money would be better directed towards co-ordination of services and patient care.

Doctors get paid enough money to do their job including all the other perks and payments from the pharma companies.

It's time they were brought back under the NHS and into the real world again.

It makes me really angry when all they seem to do is chuck money at daft ideas and not tackle the real issues head-on.

 

[LYN T]

About 10 years ago I worked for the NHS (admin) -ironically it was for MH services. Gps were given payments for doing their colleagues annual appraisals The were also given payments for attending their OWN appraisals. So additional payments don't appear to be new-but this latest news leaves a bad taste IMO.

Take care

Lyn T

 

[WILLIAMR]

With my step mother other things were suspected eg water infections etc.
Dementia was only finally diagnosed when she was taken in to hospital as it seemed to come on very quick. She deteriorated in hospital very quick.

Looking back she did do some odd things for a few months which we never mentioned to the doctor.

Unfortunately myself and her son had never come across dementia before and we did not really know anything about it.

I think if we come across somebody at the earlier stages of dementia now we would pick it up a lot quicker. In fact I warned a lady a little while ago to get her mother to the doctor as she was doing odd things in front of me.
The lady did not know what to do.
A month later I met the lady again and she confirmed I was correct.

William

 

[jeany123]

I would agree with this if it did any good but just to be diagnosed with dementia and left to get on with it is no help to anyone,

 

[Lindy50]

I would agree with this if it did any good but just to be diagnosed with dementia and left to get on with it is no help to anyone,

I agree jeany. This was just what happened to us.....GP did one of those 10-question 'who is the prime minister?' type tests, said it was "dementia, probably vascular". I think she based the last bit on the fact that mum had previously had a stroke. When I was struggling to get mum to eat, etc, and phoned the surgery, the same GP just told me on the phone there was nothing she could do. I felt so alone then, having been told such a thing and then offered no help.

I did ask for a memory clinic referral and that has been a bit more successful (only one appointment so far, though).

I guess diagnosis rates are the first step towards improved services....but even so, the idea that GP s would claim £55 (or £200 in some areas) for putting someone's name on a list, sticks in my gullet And I am generally pretty mild-mannered.....

Lindy xx

 

[Saffie]

I didn't think that GPs had the expertise to diagnose dementia.

Surely all they can do is to identify a patient who might have the condition and, after carrying out blood tests etc. to discount other reasons for the suspiscious symptoms, to refer them to a consultant who can diagnose it.

This is what our GP did. I would want to be assessed by a higher authority than a GP.
No reflection on GPs but the G does stand for 'general' .

 

[Lindy50]

I agree Saffie.

I don't see how they can be paid extra for basically recording a hunch

Although....on reading the article in the Telegraph, I see they'll also get the £55 just for recording the diagnosis conveyed to them by a consultant!!!

Words fail me.....

 

[jeany123]

I agree Saffie,I think I would be able to diagnose someone with dementia better than some doctors,

 

[meme]

a cynical vote winner...docters are paid well enough and should not need extras for doing their job properly......gp's are so rushed these days
they hardly have time for every day stuff!

 

[TinaT]

The job of a GP is to diagnose. We go to a GP with a problem and we expect the GP to help. Why should GP's be paid more for giving this particular diagnosis?

For me it is the fact that a diagnosis of dementia beings along a multidisciplinary approach to giving care and GP's seem very poor in coordinating or even taking a proper part in this necessary type of care.

I have found time and time again that doctors, social workers, district nurses etc., and all the other services which profess to be multidisciplinary, work in complete isolation of each other. In caring for my mother I have had strong instructions from the district nurse, which completely contradict the advice given by the palliative care team, and the various doctors at the practice again giving different instructions and advice.

What carers need in order to give the best care possible is a coordinator, whether it is the GP or another professional to take control and manage the different agencies involved in caring for dementia.

xxTinaT