How can GPs possibly diagnose and some people might well be diagnosed wrongly - maybe taking medications they don't need.
What's going on!!!!!
They cannot even diagnose a patient who is clearly hypothyroid and has a TSH of 100. Patient was phoned to state that 'there's nothing wrong with blood test!
I have also read that dementia can only be confirmed after death when they inspect the brain for confirmation. Some people might be taking unnecessary medications especially if if they're a bit absentminded.
GPs to be paid £55 for each dementia diagnosis.
Who is providing the monies? A pharmaceutical company?
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shaws
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My mother was recently diagnosed with dementia, by having a brain scan and sitting through a test where they ask various questions. I didn't realise the GP was paid for confirming it though , sounds unnerving to say the least!
My husband, who has Parkinson’s, has recently been diagnosed at a memory clinic and by a very experienced clinician, with mild Parkinson’s Dementia. The precursor was hallucinations and he has been on medication for these, RIvastigmine, which is also used to treat dementia. I was not surprised by the diagnosis, but my husband was shocked. Our GP did not realise that my husband had Parkinons’, despite the obvious signs and him doing simple tests, so there is no way a GP would be qualified to diagnose dementia,, with its enormous ramifications. This smacks of Big Pharma trying to make ££££ & ruining the lives of families at the same time.
Interested in any recent links please.The system is broke and there's so many risks with this. Its as though the powers at be want to push a 'Dementia' narrative with Pharma.
Possibly linked to Climate and toxins.
Mental Health is now massive across all ages and just the start IMO.
A controversial scheme to pay GPs’ practices £55 each time they diagnose a patient with dementia is to be discontinued, the head of the NHS in England has announced.
GPs’ representatives and patient groups fiercely condemned the payments, which are part of a drive to increase diagnoses of the condition, as ethically questionable and damaging to the relationship between doctor and patient.
Simon Stevens said on Wednesday that the scheme would end in March, describing it as a “one-time catch-up opportunity for practices who want to take it” and an unusual situation.
Despite the flak the scheme has received and the decision not to continue with it, he said there were no regrets about its introduction.
“I think it’s too early for hindsight,” he told medical website Pulse. “We need to look at the dementia diagnosis rate through the year before we do that. It is not driven by patient preference, but by different levels of focus on this topic.
If diagnoses are rushed it could mean wrong medications prescribed.
If GPs are ignorant about the symptoms of common autoimmune diseases patients will not be prescribed with medications that may improve their conditions.
The way GPs are paid by the NHS is very complicated. A fee for having a patient on the list, hitting various immunisation targets, doing minor operations and offering various clinics etc etc so if this is correct then it's just part of the income GPs receive for their work from the NHS. Think of it like a plumber fitting a bathroom or servicing a boiler. Different fee for a different service.
Exactly, what is far more likely is that the wording is ambiguous and what it really is is that they are paid to undertake the screening and tests for dementia rather than for each positive result they get from testing.
Hi there, I understand what you are saying but let's not forget that a GP who works for the NHS is also salaried, a full time GP earns around £100,000 per year . The money they are paid for other services is not their salary, it is an extra. I really don't sgree with these "extras", you would think giving flu jabs for example should be part of being a Doctor, having clinics running in the surgery's that have information for patients to achieve better health, blood tests, stop smoking, asthma etc... surely should be part of their NHS work for which they are paid.
GP partners are not salaried, they run a practice and the practice get paid for what the practice does. It also pays all the expenses such as staff costs, rent, heating lighting etc etc. The partners take what is left over as in any other business. Salaried doctors, employed by the practice, earn about £60 000 full time and do not take any of the target/ incentive money.
Recently large private companies have taken over the running of a lot of GP practices and employ all the GPs. The GPs are all salaried and the private company takes all the profit.
Drug companies are not involved in any way.
It sometimes scares me how incorrect scaremongering information spreads on this forum.
Also, dementia is a symptom, not a diagnosis, and can be caused my numerous things including vitamin deficiencies. A dementia screen does blood tests for this and always includes a brain CT or MRI and blood tests for thyroid diseases, B12 folate and ferritin.
I had no intention of scaremongering and resent thst remark. There are 4 GP partners in my surgery, not owned by a private company and they have declared the salaries paid to them on the practice accounts, the full time partner gets £103,000 and the 3 part time partners get between £55k - £60k. The salaries for other GP staff that have come into the surgery when required is also shown on the accounts. Nobody could afford to work for leftovers, certainly not someone who has spent many years achieving their status. We shall have to agree to disagree but thank you for your opinion.
Mollyfan 'It sometimes scares me how incorrect scaremongering information spreads on this forum.'
Admins, and members such as yourself, do their best to rectify incorrect information and scaremongering. But we can't read every single post or comment. So inevitably things will pass us by.
It's also the responsibility of all forum members to report anything that they consider falls into such categories.
I have noticed that the Report button is being used less and less these days. please everyone, if you see questionable information being posted on our forum, use the Report button so that the admin team (and HU where appropriate) can investigate.
There is a very interesting book called The Great Cholesterol Con written by a GP called Malcolm Kendrick. He reviews all the published evidence around cholesterol, the relationship with heart disease and stroke and the relevance of statins. It's written in a light amusing way but a real eye opener.
My mum is due to be assessed in her care home. She's had a couple of assessments in the past, including brain scans but as the consultant pointed out these merely show brain shrinkage which at 90 odd everyone will have a degree of as its part of ageing , and not definitive. Mum's assessments have come back as borderline so this new one she's having might be the same.
There are other conditions that can mimic dementia, like UTI's and depression. As you say GP's struggle to diagnose thyroid when it's in black and white. So I'm not especially optimistic. GP's get offered money for all sorts of things, smear tests, vaccinations, health checks etc. Sadly it sometimes feels like they're more concerned with box ticking and meeting targets than real care.
GPs do not make the diagnosis, they do an initial screening test and refer on for further investigation including a full assessment, bloods and CT/MRI.
It's not even a GP coming out, just a clinician from the surgery, mum's assessment was due last week but the clinician who came out couldn't do it as mum had been taken off her list, you couldn't make it up.
Like any procedure you can opt out. You can't be forced to undertake any assessment. I think people don't always realise that you don't have to consent to have investigations, whether it's a blood test right through to invasive surgery.
I think we still have too much deference to the medical profession on the whole. Well not on this forum admittedly 😄
Dementia can definitely be diagnosed when people are alive my father in law has dementia pretty bad started about 3 years ago with sudden anger and forgetting things like going to the bathroom. My poor mother in law never leaves her house anymore its like she has a toddler again. Its sad.
What’s wrong is paying doctors to make diagnosis for dementia this sounds unethical and opportunity for lots of misdiagnosis … I think the medical communities have lost their minds and need to be cracked down on before things go off the rails.
I 'think' that in the USA doctors get paid more for additional diagnosis. This is a part of the following link:-
"The clinical care business business models employed in American medicine puts doctors at odds with their patients, say Ian Larkin, a UCLA professor of management who specializes in compensation, and George Loewenstein, a professor of economics and psychology at Carnegie Mellon. But that kind of conflict of interest is rarely recognized or discussed, according to their editorial in the Journal of the American Medical Association on May 2.
Still, there may be a relatively simple solution to this thorny problem of doctor pay being linked to patient care. Pay doctors salaries, they say, and this conflict will be eliminated.
Larkin and Loewenstein argue that much research and discussion of conflicts of interest in medicine focus on physician interactions with pharmaceutical and medical device companies though relatively few doctors actually have substantial financial relationships with these businesses. On the other hand, compensation structures for doctors are almost always tied directly or indirectly to the services they order for patients, which makes their pay the most pernicious conflict of interest in medicine, even if least discussed.
“Fee-for-service or volume-based reimbursement, which by one estimate determines payments for nearly 90% of US physicians, provides incentives for physicians to order more and different services than those that match patient need,” write Loewenstein and Larkin. They suggest that if doctors were paid salaries, they’d be more inclined to practice medicine that meets patient needs, and could also be happier in the profession, which typically experiences high burnout rates.
According to their research, the current compensation structure causes both physicians’ needs and clients’ health to become dueling factors in the services they render. It is, however, very difficult to study or quantify the compensation problems and determine with any specificity how many services for patients are recommended or ignored motivated by doctors’ pay needs, the editorialists note.
Still, compensation, the way workers get paid for what they do, is widely understood to have known and unknown consequences. “The vast majority of physicians care first and foremost about their patients. But a significant body of literature in the social sciences demonstrates that financial incentives can and do influence decisions in ways not recognized by decision makers,” write Larkin and Lowenstein.
They argue that doctors don’t necessarily know that they are motivated by payment when making treatment recommendations.
Nonetheless, concern about compensation is only natural and it can negatively influence physicians.
Doctors don’t go into medicine because they love its business models. But they also can’t afford to ignore compensation. Loewensten and Larkin suggest that a new approach to practicing medicine in the US would make the health care system and the individuals it serves healthier, while making doctors happier.
Being from US . It's just another thing to worry about . As if we needed more worries? But it's so ironic when it comes to thyroid meds NDT T3 they look the other way. Does that make any Dollar's and Cents???
I agree with your comment. We're thankful on this forum to have excellent and knowledgeable Advisers. The pity is that few Endocrinologists seem to read researchers reports.
If you want to highlight anything in your post put an @ before the word i.e. Tythrop and you will see the word turns blue but the person will be notified.
Just to play devil’s advocate here…I went with my mum to her doctor as I knew something was seriously wrong. He did the memory question test which she failed disastrously.
He admitted she had a problem but said diagnosing dementia would ‘label’ her and that might cause problems for me in the future.
Two (difficult) years later we saw a different GP in the practice who asked if we had done dementia tests. I repeated what her colleague had said. She was silent for far to long, then said that would not have been her opinion. So finally she was assessed by a consultant, was diagnosed and started treatment. Eventually we got a place in a nice home.
If the first doctor had been paid £55, would his diagnosis have been different, and would earlier treatment have made any difference to mum?
You are not playing Devil’s advocate at all and demonstrate why screening people for dementia can be useful. The drugs do work and the earlier they are started the longer someone is able to live independently. The practice is paid to do the assessment and may we’ll employ someone specifically to do this. That costs money!
Declaration of interest….
My father died of Lewy body dementia and my father in law has advanced Alzheimer’s. We have been able to keep them both at home and there is no doubt that the drugs have helped. Dementia is horrific and, in my opinion, anyone who develops any form of dementia deserves every bit of help they can get.
It's great that they are still in their own homes. It must be awful for many who're newly diagnosed to be taken from their home and nothing is recognisable in the new 'premises' that could make them feel at ease. It must also be very scary. Most times they may not recognise members of their families.
They are one of the worst collections of diseases that exist. My dad was diagnosed in 2011 and died in October. He was bed bound and incapable of doing anything ( even sitting up) for the last 5 years. I honestly feel that anything that can be done to help, either in terms of medication, support or education is a good thing. The government had a drive to improve diagnosis and support for people with dementia in order to help, not make things difficult. The NICE guidelines dictate the assessment process, including establishing the cause of the dementia ( Lewy, Alzheimer’s, vascular, Picks, Huntington’s, Parkinson’s etc) as well as ruling out other causes such as thyroid deficiency and anaemia/ vitamin deficiency, brain tumours etc. in order to provide the best solution. I honestly think the intention was sincere and, in fact, GPs raised concerns about how it would look. The whole system of funding extra workload for GPs is mad and ( in my opinion) needs a complete overhaul, but it is not as cynically corrupt as some people suggest.
I'm sorry to hear of your family experiences and glad to know that some attempt is being made now to exclude other contributory/causatory factors, even though we know how difficult it can be to accurately assess B12/folate status and thyroid function. My mum died with dementia in 2011 and I know that those had not been properly checked, sadly, along with some other factors that are clear now within the family. Best wishes
I am so sorry to hear that your mum was not checked thoroughly. I think the reason the government focussed so much on the diagnosis of dementia was to try and prevent the variation in the standard of diagnosis and care. The NICE guidelines help this too. Let’s hope things have improved. All the best.
I thought this might be interesting….. a list of tests required in the NICE guidelines for the assessment of patients with cognitive decline to exclude reversible causes. Thyroid function, folate and B12 are standard, thankfully.
As I've explained, they are 4 partners who are salaried and also get paid for the "extras" they provide, that was the point I was making. It is my own opinion that the NHS needs a huge overhaul, after working for a pharmacist( not a chain) it certainly opened my eyes to charges made and payments claimed from the NHS .
If they put all the money into dementia research and future treatments I think that would be a better use for it. There's something unethical about paying a Dr for a diagnosis and the validity of a diagnosis as you say, is also going to be in question. Imagine if police were paid for each suspect they charged...
Thank You Shaws for another eye/ear/brain opening alert. Is this just another of Big Pharma's Shenanigans of making M-O-N-E-Y ???? Does this ever stop???? What next????
doctors get paid whether they get things right or wrong.How often do thy get it wrong? How would you know that they were getting
things right? You start to feel better? Unfortunately they make a great deal of
mistakes and surgeons perform lots of unnecessary operations. Covid has meant millions of people not getting seen and who knows how many are getting worse or dying as a result? But notice that Pharmaceutical Cos have raised the
amount paid to doctors per shot vaxxing people to £15 w/days on Sunday its £20. And they are due a pay raise. Lucky for them they are not paid by results. Those earning the most from the health business are firms like Pfizer who expect to earn £128 billion this year thanks to "Covid". To put that in perspective BP the giant Oil Co reported profits of £12.5 billion. So Pfizer
earnings will be 8 times BP.
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Totally off topic but......
Endocrinologist W.Midlands/Warks
