Jonathan Fine discusses the balance of ethics, between practices making money and quality treatment of patients.
As a general practitioner (GP) you now earn £55 when you diagnose dementia, £107 when you find cancer and £9.70 when you see an ingrowing toe nail. Well, actually only the first one is true, but what’s stopping the other two from happening?
The dementia scheme offended a lot of people but they missed the point: it’s an emergency. Less than half of the UK’s estimated 800,000 dementia cases have been diagnosed and David Cameron wants it to be two thirds by 2015, dementia and Alzheimer’s disease are now the biggest cause of death among women and ranked third for men.
Hard to diagnose
A report released by the Medical Research Council in October found a quarter of people with dementia hide their symptoms through shame and fear of stigma and so you can see why hard-pressed GPs needed reassurance that spending time on these cases would still be profitable for their practices.
The £55 bounty may not be perfect but it is expedient in a health service engulfed in cuts and uncertainty and, because of the media headlines, it marks a tipping point in the way we see GPs; they now seem a bit more commercial, a bit less ethical.
The financial incentive is how most of the commercial world works, directly or indirectly. The question is; would you feel better attending your GP’s surgery knowing that he or she is actively looking for things wrong – even if they are making a few quid out of you?
Financial incentives
GP services are getting worse (two thirds of doctors, nurses and practice managers believe standards of basic GP services have fallen in the past 18 months), so if you were given the choice of attending a GP who gets paid a flat salary whatever his diagnostic performance level or one paid on diagnosis performance, which would you pick?
Of course, what happens after a disease like dementia is diagnosed is another problem. Currently it is common to wait 26 weeks for an assessment, after which many people enter a disjointed system that relies largely on care by family members (£11.6bn of the £26.2bn spent on dementia care a year is unpaid, according to the Alzheimer’s Society).
But the right financial incentives could also help here by driving resources to the most effective carers. Admiral nurses, for example, are specialists in dementia care and a study by the NHS found that just one of them saved the health service £443,593 in a year, in reduced contact with GPs and nurses, and in the eight mental health bed referrals that were avoided. Incredibly, there are only 130 admiral nurses in the UK, and guess what could expedite growth in numbers: financial incentives.
UK dentists lead the medical world in balancing commercial imperatives with ethics, and the sooner these bright dentists start transferring what they’ve learned over to private GP practices, the better for everybody, including NHS practices and patients. What are we waiting for?
If you’re interested in exploring this opportunity, please call Jonathan on 07860 672727. For business tips every fortnight subscribe to Breathe’s newsletter at www.breathebusiness.co.uk.
