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Bribing doctors to give a specific diagnosis is not a good idea

March 2019

White coated doctor with money
Public trust in doctors can be undermined by cash incentives

The idea of paying doctors additional money to make a specific diagnosis is back in the news again.

For those of us brought up in a slightly gentler era, when we respected our doctors and adhered to their advice with a reverence that modern generations would find comic, it seems a very strange notion indeed to encourage doctors to make a specific diagnosis through the offer of a cash bonus.

Yet that is indeed what happened five years ago when NHS England thought it a good idea to up the number of patients diagnosed with dementia.

They brought in a scheme that offered a £55 bonus for every doctor who diagnosed a patient with this problem.

In many ways it seems an incredible idea, after all doctors are people and in the law of averages a percentage might be tempted to swing possible symptoms in favour of a diagnoses for the extra cash. When a recent survey says doctors see an average of 11 to 20 patients a day, finding just 5 new possible cases of dementia a week, even in its earliest stages, could produce a useful additional cash flow of £2,000 a month!

On top of that, it seems some individual schemes introduced by certain sections of the NHS offered doctors as much as £200 for each patient diagnosed with dementia.

In all fairness, the NHS said the scheme was in response to an estimated 90,000 people who might be living with undiagnosed dementia; and the idea was to try and encourage early diagnosis. The scheme may have brought some success; research indicates that among everyone estimated to suffer from dementia, the numbers officially diagnosed with the problem rose from around 52 per cent to 69 per cent.

But that also means quite a tidy sum in cash bonuses for the lucky or determined doctors who managed to diagnose new cases of dementia.

Then, surprise, surprise, a new report from researchers at the University of York now shows that the scheme of cash bonuses for a specific diagnosis undermines a patients’ confidence in their doctor.

The researchers in York examined more than 7,000 practices in England which were involved in this cash for diagnosis scheme and found that the incentives were associated with a significant fall in people’s confidence and trust in the GP.

It is not just the general public that found the idea of paying doctors for a specific diagnosis somewhat bizarre. A member of the British Medical Association’s GP committee said that decisions about an individual’s care should always be based on clinical need and not financial imperatives. He said that while diagnosis of dementia is important, it should not be done in a way that could seriously undermine the relationship between a doctor and the patient.

A local GP in Guildford in Surrey said it is important that it is made clear that doctors should never be paid on the basis of diagnoses.

One finally hopes this scheme has been put to rest; but there are still occasional financial rewards and other incentives in place for family doctors. There were a number of reports last year on practices being given “cash back” for preventing patients from going to hospital with one investigation showing that one in four NHS authorities had introduced financial incentives for GP practices to reduce the number of hospital referrals for patients. There is a lot of information on line such as a story on how GPs may be paid to prescribe ineffectual drugs.

But another less known fact is that many GPs are self employed, with GP partners owning the business of the medical practice and operating as independent contractors to the NHS. Generally the doctor will receive a set amount of money per patient on their list each year; they are not paid per visit. Also worth knowing is that doctors, despite all their training, do not instantly enter the higher tax bracket. Most junior hospital trainees at Foundation year 1 will start at just over £27,000 a year, despite the training they have already done and the level of commitment and responsibility they need to show.

These are challenging times for family doctors, especially as we often arrive with opinions on treatment anyway, having previously checked our symptoms on the internet. Most of our very hard working and dedicated general practitioners today show incredible professionalism and knowledge and still deserve our total respect...but, as this latest report from Yorkshire University shows, bribing them to make a specific diagnosis will not help to maintain public goodwill.

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