Intended for healthcare professionals

Letters Open letter

An open letter to Simon Stevens, NHS chief executive, and Alistair Burns, national clinical lead for dementia

BMJ 2014; 349 doi: (Published 06 November 2014) Cite this as: BMJ 2014;349:g6666
  1. Martin Brunet, general practitioner1
  2. On behalf of Margaret McCartney, GP, Glasgow; Katherine Murphy, chief executive, Patients Association, UK; Iona Heath, retired general practitioner, former President Royal College of General Practitioners; Beth Britton, freelance dementia campaigner and consultant; Kailash Chand, NHS campaigner, chair of Healthwatch Tameside; Sally-Ann Marciano, registered nurse and dementia campaigner; Trish Greenhalgh, professor of primary health care and dean for research impact, Barts and the London School of Medicine and Dentistry; Laurence Buckman, GP, Temple Fortune; Gill Phillips, creator of Whose Shoes; Richard Lehman, honorary senior research fellow, University of Oxford; Tim Ballard, GP; Andrew Green, chair, GPs’ clinical and prescribing subcommittee, BMA; Peter Gordon, locum psychiatrist for older adults; Sue Wilson, daughter of person living with dementia; David Nicholl, consultant neurologist, City Hospital, Birmingham; Martha Pollard, PhD in public health and carer support worker; Julian Treadwell, GP, Bath and North East Somerset; Simon Poole, GP and member of general practitioners committee; Joanne Reeve, academic GP, Liverpool; Chris Roseveare, consultant physician in acute medicine, University Hospitals Southampton NHS Foundation Trust; Sarah Wookey, GP, Banbury; Aseem Malhotra, consultant clinical associate to the Academy of Medical Royal Colleges; Jane Wilcock, GP, lecturer at University of Liverpool; Anthony Ward, consultant physician in rehabilitative medicine, North Staffordshire Rehabilitation Centre, Haywood Hospital; Chloe Evans, GP, Chieveley; James Larcombe, GP, County Durham; John Cosgrove, GP, Birmingham; Geoff Wong, GP and senior lecturer in primary care, London; John Bye, GP, Middlesbrough; Ahmed Rashid, academic clinical fellow, University of Cambridge; Stephanie de Giorgio, Cedars Surgery, Walmer; Lesli Davie, GP, Rugby; David Warriner, cardiology registrar, South Yorkshire; Andy Fugard, lecturer, University College London; Jonathan Sleath, GP, Hereford; Helen McKendrick, GP, Liverpool; Helen Hollis, GP, Nottingham; Wiliam House, retired GP; Samir Dawlatly, GP, Birmingham; Lis Davidson, GP, Liverpool; Martin Duerden, GP and clinical senior lecturer; Gavin Francis, GP Edinburgh; Dan Petrie, GP, Corby; Sara Bodey, GP, Wales; Sarah Matthews, Sky Blue Medical Group, Coventry; Sally Lewis, GP, Wales; Torquil Duncan-Brown, GP, Lichfield; Katy Gardner, GP, Liverpool; Philip Rathbone, GP, Melton Mowbray; Ellen Wright, GP, Greenwich; Alison Hughes, GP, North Wales; Louisa Polak, GP, Colchester; David Taylor, locum general practitioner; Edward Clarke, Vauxhall Primary Health Care, Liverpool
  1. 1Binscombe Medical Centre, Godalming GU7 3PR, UK
  1. martin{at}

We are writing to voice serious concerns regarding the new dementia identification scheme for GPs, whereby English GPs are to be paid £55 (€70; $88) for each additional diagnosis of dementia made before the end of March.

Helping people affected by dementia to achieve a diagnosis is a worthwhile goal, but the means of achieving this must have a sound ethical basis. The introduction of a financial incentive to the making of a diagnosis has broken new ground in the national GP contract and set a dangerous precedent that needs to be urgently reconsidered. The diagnostic process is unique in the doctor-patient relationship because the patient has to trust the doctor’s judgment. It is extremely difficult for patients to challenge their diagnosis; they are unable to “opt out” or be “exception reported” from a diagnostic label as they are with other incentive schemes, such as the Quality and Outcomes Framework, or a screening programme. There must, therefore, be absolute surety that doctors have no other motivation than the patient’s best interests when they make a diagnosis. A direct financial payment like this undermines this confidence, and with it the basis of trust inherent in the doctor-patient relationship. Patients who may have dementia are particularly vulnerable, owing to the nature of an illness that causes cognitive difficulties; and the diagnosis is a subjective, clinical assessment, meaning that misdiagnosis is a real possibility. To be given a diagnosis of dementia is challenging when the diagnosis is correct, but to receive such a label incorrectly can have truly tragic consequences.

This scheme may have good intentions, but it has crossed a line that should never be crossed and contravenes good medical practice. The reaction of the general public to the story is a demonstration of the widespread concern that the policy is unethical, and we ask for it to be withdrawn without delay.


Cite this as: BMJ 2014;349:g6666

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