Could there really be a medical bounty on your head

Friday 14  Nov, 2014 

  • Find out if you are ‘Wanted’ by your GP to earn a healthy buck

  • Discover why the nation is failing to tackle dementia properly

  • Here’s a simple problem with a complex solution – it involves money!


Just for fun, you understand, I thought to enjoy a gentle quip with my GP when I saw him at the pub last Sunday.

“Now Doc,” I said, “I know an awful lot of ageing folk and I reckon I can point them your way for a dementia diagnosis, as long as you’ll split the £55 with me!”

What followed was reminiscent of a few of the fireworks from Bonfire Night.

“Don’t you start Collins” he exploded, “I’ve had nothing but grief for the last two weeks since some foolhardy idiot decided that this was a good idea.”

By now he was reddening in the face and I began to realise that I’d touched a nerve.

“Why in the name of all that is holy would I want to section someone for the sake of £55?” he roared. “The whole idea is a complete disaster, and is just destroying the patient and doctor relationship.”

It was as much as I could do in the face of this onslaught to offer to buy his beer for him.

Tact and diplomacy were never my strong points but I had no idea that feelings were running so high about this recent government initiative.

In case you missed the story:

Basically NHS England will pay your doctor a fee (assumed to be £55 per person, but in some areas figures of £200 have been mentioned) if they diagnose you with dementia in a scheme ending in March next year.

The claim is that rates of diagnosis are woefully low and that those in need of help are not being identified early enough.

Jeremy Hunt, the Health Secretary, said it was a “national shame” that just half of those with conditions such as Alzheimer’s disease are properly diagnosed, with a new target of two thirds being put in place as a result of this move.

But, like my own GP, the medical profession are not of the opinion that offering a diagnosis bounty is the way to improve the situation.

To my mind they are right, what we are witnessing is typically flawed thinking by our leaders – once again.

Tackling dementia properly

The situation is really rather simple to understand, but incredibly complex to address – by that I mean the politicians find it complex because it involves money that they aren’t trousering.

We have an ageing population who are living much longer than any generation before them, which increases the number of people presenting with the various forms of mental deterioration.

Care for those in need is expensive and in short supply with much of the burden falling on family members.

Even by receiving a diagnosis of dementia there is no real ‘help’ available – those of us with parents who are in the early stages of Alzheimer’s and other forms of dis-regulated mental function know this all too well.

When questioned by the Daily Telegraph about why the NHS wanted to drive an increase in diagnosis a spokesperson said: “Dementia can be devastating both for individuals and their families. We know that more needs to be done across the health service to ensure that people living with dementia are identified so that they can get the tailored care and support they need. This additional investment is part of a drive to ensure this.”

The big question is what ‘tailored support’ is available?

In reality there is no such thing; the process is to leave the sufferer in the care of the family and then charge the earth to have them in private care homes thereafter.

Where is the care in that?

Even the BMA, the body representing GPs, said they believed the problem with dementia was not about diagnosis, but about providing patients with the condition with enough support. 

So as I said, diagnosis and identification of need is the easy bit – where the entire process fails is that once diagnosed there is no care and support available.

This means there is no incentive for anyone at home to seek an assessment as after all the messing around and time it takes there is absolutely no advantage.

And the fact that there is now a payment to be made for every patient identified is just a false and misguided policy – surely it is just paying the doctor to do what they are already paid for anyway?

I understand fully the response I got from my GP because so many commentators have made the same point he made in regard of the patient/doctor discussion.

If he starts to suggest an assessment for dementia for me am I more likely to think that he is doing his best to help me, or just looking for an easy wad of cash?

By opening this debate the NHS are laying themselves open to a huge backlash.

If the diagnosis rates for these conditions goes up by ten percent or more what are they going to do to help those who are recently diagnosed? They can’t cope as it is.

Provision of care at breaking point

If you look at the statistics, most sufferers end up paying themselves for care services from what is known as informal carers – basically individuals trained in the support of daily tasks like washing and dressing but not able to offer much more.

Within the formal care system, involving NHS hospitals and care homes the service is at breaking point with many regions of the UK being identified in the Alzheimer’s society report (published in January this year) as failing to treat people with dignity and respect. 

This report goes on to identify four key principles of care as that which is:

Provided by staff trained in providing good dementia care, who have access to specialist support 

Focused on meeting needs and aspirations 

Promoting of dignity and respect and maintaining human rights 

Closely coordinated between different professionals and services across health, social care and housing.

Looking at this list it is hard to disagree that these are the basic minimum any of us should expect at a time of need – it is just a real shame that the millions of pounds that will be paid out under this ‘bounty hunting’ scheme will not deliver any of this.

It really is about time that care was funded and focused on those in need, both sufferers and carers alike.

Yours, as always



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