Dementia targets 'harm patients'

Linking dementia diagnosis targets to funding could cause patients 'substantial harm', a GP has warned.

There needs to be an urgent debate before such practices get 'out of hand', said Dr Martin Brunet.

He fears that patients could be unnecessarily diagnosed with dementia as part of efforts to reach targets tied to financial incentives.

Dementia map

Health secretary Jeremy Hunt published a 'dementia map' in November last year that enables people to view dementia diagnosis rates in their local area.

He said the map would help to drive up standards by showing how dementia care should be provided.

However, Dr Brunet has written in the British Medical Journal (BMJ) that such 'naming and shaming' of areas with lower diagnosis rates leads to pressure to over-diagnose the condition.

GPs feel ‘pressure to diagnose a patient with dementia'

And he warned that clinical commissioning groups (CCGs), which are the teams of GPs overseeing NHS budgets, are already tying diagnosis rates to income.

GPs will feel undue pressure to diagnose a patient with dementia when an individual may actually be suffering cognitive impairment that could improve without treatment, according to Dr Brunet, who is based at Binscombe Medical Centre in Godalming, Surrey.

He said nothing more than an individual's best interests should come into play when a doctor is faced with a patient.

On the issue of the stigma associated with a low diagnosis rate, he commented: 'CCGs listed among the 10 worst in the country will be desperate to remove themselves from such scrutiny, and at least one CCG has made the goal into a financial target.'

He said Herefordshire CCG has written to local GPs to inform them of the need to increase diagnosis rates.

Dr Brunet quoted the letter as saying: 'The CCG needs to increase prevalence to 40% by April 2014 and 50% by April 2015 - and will lose significant income if we miss these targets.'

An accurate diagnosis can bring great benefit to a patient

He said a graph was attached to the letter showing the diagnosis rates for each practice in the area 'with the implication that those with lower rates needed to work hardest to help the CCG earn this income'.

An accurate diagnosis can bring great benefit to a patient in terms of opening up effective treatments and support, but likewise an incorrect one can bring 'great harm', the GP warned.

Dr Brunet added: 'The idea that doctors should be motivated by self-interest, such as personal or corporate gain, is abhorrent and undermines the basis of the relationship (with a patient).'

Copyright Press Association 2014