Following on from last week’s pontification on the connection between professional knowledge and products, we learn this week that general practitioners are to be paid £55 for diagnosing dementia.
While doctors currently receive payments for conducting asthma reviews and ensuring that patients with high cholesterol are prescribed statins, this move to make payments for the actual diagnosis of a condition is a first.
Now, I am convinced that all doctors are completely ethical and professional. Their diagnoses or prescriptions would never be swayed by payments, however big or small, from whatever source.
In fact it seems to me that GPs could argue that if they received a payment for this diagnosis, which they would have made anyway, this would represent revenue to the practice which could cross-subsidise the costs of services rendered to other patients.
Of course, I would have to make a diagnosis in the first place to receive the payment, but there are probably a few patients who would not mind going through the rigmarole of being diagnosed in return for a share of the payment.
Calm yourselves. These oblique references to discussions on these pages and elsewhere about professionalism, ethics, commission bias and inducements is all tongue in cheek. Well, almost.
What interests me is that the first and most outraged reactions to the proposal came from the doctors themselves, one of whom is reported as saying: “NHS England have either not considered the ethics of this new policy, or are so blinded by their goal that they don’t deem ethics to be important …”
He continued: “There must be absolute trust that the doctor is acting only and solely in the best interests of the patient. To contaminate this process with a financial payment seriously undermines the doctor-patient relationship in a new and pernicious way.”
Given that GPs are currently paid to undertake the assessments for dementia, one wonders why there is an apparent under-diagnosis. Are the assessments no good? Are the doctors no good? Are the patients not actually suffering from the condition? Perhaps the assessments are fine and the doctors have diagnosed accurately, but they see no point in giving patients news of a devastating condition when treatment, care and support for patients and their families are also woefully under-funded.
The moral of the story? Spend the equivalent sums of money where it will actually do some good. Which leads me neatly onto considering the delivery of the guidance guarantee next week.
Spend the equivalent sums of money where it will actually do some good.Gill Cardy is network development director of ValidPath
