GP dementia charging: the profit motive has no place in healthcare

The introduction of mechanisms that mimic the market add unnecessary levels of bureaucracy.

The introduction of mechanisms that mimic the market add unnecessary levels of bureaucracy

The plan to pay GPs £55 for each patient they diagnose with dementia has rightly been condemned as ‘odious’: it’s a threat to the trust between patient and doctor. Patients will wonder whether the diagnosis they receive is coloured by the lure of extra cash, rather than clinical need.

But it also illustrates, very clearly, what’s wrong with our approach to the NHS, and many other public services today.

We’re taking a service that relies on professional skills, compassion, caring, and treating it as though it concerned the manufacture of widgets.

Performance-related pay, of which this is just a particularly gross example, might make some kind of sense in a factory, or at least one where each worker has the same tools and makes each item personally, but in the many other environments in which free market ideology has placed it, the effects are distorting, damaging, even disastrous. As of course it has been in our financial and commercial sectors, with their runaway bonus cultures.

We’re surely going to see more of this damage in the teaching profession this year, as performance-related pay continues to be introduced. Putting even more pressure on teachers to teach to the test and pitting them against each other will do little to give pupils a good, rounded education in a healthy environment. We know that only a team of teachers, assistants and support staff, working with the pupils themselves and parents and carers, can together give pupils the skills and knowledge they need.

We’ve already seen the impact of performance-related pay in the NHS, where the focus on financial targets at Staffordshire Hospital caused immense pain and suffering.

But there’s an even deeper problem which the £55 diagnosis fiasco exposes. That’s the market mechanism, competition instead of cooperation, being used as a way to manage and run the NHS.

That’s what Professor Allyson Pollock’s NHS Reinstatement Bill aims to tackle: to end the division between purchasing and private bodies, and to severely restrict the role of private companies in provision of NHS services. The Green Party is entirely committed to its central principles.

The Green Party says the profit motive has no place in healthcare, and the introduction of mechanisms that mimic the market have added unnecessary levels of bureaucracy, and acres of paperwork, to the costs of the NHS.

I was privileged to be able to join the People’s March for the NHS last month for a day. I heard from the healthcare workers who made up the majority of the marchers. They told me of the impact of NHS privatisation, the massive costs of Private Finance Initiative schemes that have done such damage to healthcare in so many areas, and the destructive effects of this government’s wholesale reorganisation of the NHS.

Not only are we handing over our facilities and services to multinational companies that come out of the disastrously poor and expensive American healthcare system, not only are we slashing funding for essential NHS services and imposing massive “efficiency savings” that began with Labour and have continued with this government, but we are imposing a costly, damaging market approach where it doesn’t belong.

Let’s hope this furore will help shine a light on the problem, and build support for the removal of market mechanisms from the management of the NHS.

Natalie Bennett is leader of the Green Party

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28 Responses to “GP dementia charging: the profit motive has no place in healthcare”

  1. Peem Birrell

    >>the profit motive has no place in healthcare

    Tell that to the pharmaceutical industry

  2. gwilym

    Flawed. With an artifical bar such as this it is going to make sense to err on the side of caution and over-diagnose to the detriment of other illnesses…in another context Wilde commented on the unspeakable in pursuit of the uneatable – tories and cash…

  3. Leon Wolfeson

    But there also has to be a healthy discussion of science in medicine, and what works for patients.

    And that, given the Green party’s opposition to GMO-based medicine (or are you hypocrites?) and other science cannot provide.

    (Moreover, Labour massively increased funding and then looked for efficiencies, which is the right want to do it – NHS performance was just getting to where it should have been for the funding when the Coalition’s disorganisation hit, slashing care budgets for burocracy and demanding “efficiencies” at a time of falling resources!)

  4. Mapesbury Green

    Alzheimers disease international reported that over 75% of people are undiagnosed.
    Whilst Alzheimers Society have also reported that access to timely diagnosis of dementia remains variable depending on where you live.

    “In some areas, less than 40 per cent of people with dementia have a diagnosis while, in others, more than 75 per cent of people with dementia are diagnosed (Alzheimer’s Society, 2014).” Provision of post-diagnosis support is patchy at best.

    As much as a Green I am against privatisation and commercialisation of the NHS etc, you still have to work within the system that you’ve got until it is changed.

    The reality is, for whatever reason people are not being diagnosed. These targets can be a pain for GPs as they have to think about something different each day, but they have been shown to be effective at sharpening peoples minds.

    Alzheimers Society called for these existing policy measures of financial incentives to be used to achieve the governments ambition of 66 per cent diagnosis by 2015. Once rates of diagnosis are up the idea is that a stronger argument can be made to commissioners for post diagnosis support.

    If Alzheimers Society have called for this, it is because they have the interests of people with Alzheimers or other forms of dementia close to their hearts.

    GPs have a multitude of other priorities and the diagnosis of alzheimers and post support has been low down their list and deserves to be brought up their list.

    Until the system is chanced (Everyone vote Green) these are the tools that organisations and charities have to instigate change within services.

  5. Leon Wolfeson

    Not really, charities are interested in promoting their own interests a lot of the time, and in this case the massively negative consequences for the NHS are more important.

    It can be seen what the pursuit of profit has done to UK dentistry.

  6. Mapesbury Green

    However, people are living longer and as such more and more people are getting to the age where they will develop the condition. Clinical Commissioning Groups work by the profile of their areas on pure number crunching grounds. If only 25% of people with the condition are diagnosed within an area, then they are not going to allocate NHS resources to the appropriate support services to better help the 100% people who have the symptoms of diagnosis and their families.

    The system is currently broken, but this is what people have to contend with.
    “points mean prizes”

  7. Mapesbury Green

    With dementia, better to be ‘over diagnosed’ as you’ll have a pleasant surprise than miss out on support.

  8. Andrew Wedgwood

    I find it quite disgusting that someone could be paid more money if they finds he can decide more people they can diagnose with dementia. I go back all the time to the time honoured mechanism that one is paid to do the best you can at your job. Quality and pride in ones workmanship not quantity. As a young man if I worked too fast milling out piston rings on my lathe I’d make mistakes and the quality inspector would be talking to me about my substandard work. If he paid me more to work faster and never mind the quality then many engines would fail and the reputation of that firm would be affected and I might become unemployed if orders dried up.

  9. Mapesbury Green

    They should be privatised too as after all they are a public service, receiving public money.

  10. Leon Wolfeson

    People *were* living longer and longer. But anyway…

    And there are answers other than this simplistic one of bribes. Moreover, you are making assumptions as to funding for support services, which can only be reduced (as new borrowing is out, remember?) by said bribes.

  11. Peem Birrell


    But if you mean nationalised … which country should nationalise them and thereby ensure they have no pharmaceutical industry?

  12. Leon Wolfeson

    Erm…no, generally the UK does not invest directly in private pharmaceutical firms drug studies, unlike America.

    A good deal happens via Universities, but more state control there is the last thing which is needed.

  13. Leon Wolfeson

    Except, of course, “dementia” is a wide variety of conditions, and is diagnosed on symptoms – many of which can be related to other medical issues.

    It’s nothing like as simple as the diagnosis rates for the removal of i.e. appendixes because of appendicitis, where if a doctor removes no healthy ones then he is very very probably missing ones which will then burst and cause peritonitis.

    (Which is truly nasty indeed, hence the principle…)

  14. Mapesbury Green

    Unfortunately, the healthcare system responds to these bribes. The main focus for managers is money and they will place pressures on people to achieve whatever targets to meet these bribes. These bribes are then predominantly met, or if not met achieved a darn-sight better than they were previously. The system has known for year, longer than this parliament and the last that dementia has gone under-diagnosed. They’ve run out of other options really… unless we vote for a party for change.

  15. Mapesbury Green

    Yes indeed!

  16. Mapesbury Green

    Who do you think its the biggest purchaser of drugs in the UK?

    The NHS. Who pays for the NHS, we do. The NHS is reliant on drugs and the drugs are part of the public service that the NHS provides. Therefore public money is paying for private companies. Only in August Roche was blackmailing NICE to persuade them to make us all pay for Kadcycla which was priced above our maximum cost for drugs. Whilst just previous to this the government was aiming to intervene ‘in the national interest’ in the sale of astrazeneca to a foreign investment consortium. If we owned our own drug company we could lower the cost to the state via the NHS and also offset the cost of some drugs that we didn’t create. We could then buy the more expensive drugs such as Kadcycla. The NHS spends billions a year on drugs, if we had a government that thought about the long term we would realise we are always going to need drugs. We pay for the education of the scientists to go work for these private companies when the money could come back into the system.

  17. Leon Wolfeson

    That’s not the same thing as developing the drugs.

    If you want companies to refuse to sell to the NHS, you’re going the right way about it.
    If you want to set up a company to research drugs, then fine, but it’s going to cost the UK taxpayer a lot.

    And you get back tax from those scientists wages….

  18. Leon Wolfeson

    So your answer is bribes. To throw cash away, rather than fix broken systems.

    And you’re arguing for not voting for change then, as far as I can see.

  19. Concerned

    Why should GP’s be paid extra for just doing their job?

  20. Sue

    I really don’t have a problem with GP’s being paid for every dementia case they diagnose…. the huge problem (The Elephant in the Room) is were do they then refer these cases onto…. We have a totally inadequate system or actually almost NO system in place for these many many cases …. or as I prefer to call them.. People.. !! Yet another case of lets bash the GP’s … keep the masses occupied squabbling amongst themselves and they’ll not notice what’s really going on…. The GP’s are on OUR side…. remember who the real enemy is here !!!

  21. sue

    I really don’t have a problem with GP’s being paid for every
    dementia case they diagnose…. the huge problem (The Elephant in the Room) is
    where do they then refer these cases onto…. We have a totally inadequate
    system or actually almost NO system in place for these many many cases …. or
    as I prefer to call them.. People.. !! Yet another case of lets bash the GP’s
    … keep the masses occupied squabbling amongst themselves and they’ll not
    notice what’s really going on…. The GP’s are on OUR side…. remember who the
    real enemy is here !!!

  22. Leon Wolfeson

    Again, the problem being your bribes will come out of the system which follows, so…

  23. treborc1

    I asked my GP for a copy of the page of my medical record which has my conditions listed and a page with my medicines and I also had a page with my out look, three pages cost to photo copy lets be nice and say £20 each.

    I paid £350 to have them photo copied and placed into an envelope it must have taken twenty minutes .

    And by all accounts most GP’s in my area are making a killing because of WCA and now PIP’s money makes the world go around.

  24. Jill Hopkins

    Surely money cannot be allowed to be the only incentive, it is bound to distort doctor patient relationships. See Richard Titmus’s The gift Relationship refers to blood donation in UK compared to USA purchase system and reduced quality of blood products etc …I can think of better ways to spend health service cash, mainly preventative stuff. Jill Hopkins

  25. foo

    There is nothing wrong to use incentives. If GPs respond to financial incentives, then apply economic incentives. You could wish for other incentives (like respect and admiration from the local community) or just professional ethics and personal morals to ensure that a diagnosis are made correctly and efficiently, but if those components are not enough, then they are not enough. Simple as that. I would question the suitability of this specific incentive though – this incentive will likely produce many false positives.

  26. foo

    Argh. I really wish for an edit function. First bit should read “There is nothing inherently wrong with using incentives.”

  27. foo

    and again, “apply financial incentives”, not economic. “Financial” implies money in one way or another, “economic” something that satisfies the individual GP’s utility.

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