Target diagnosis rates in primary care are misleading and unethical

I “undiagnosed” a patient’s diabetes recently. It wasn’t easy: we are so unused to removing a patient’s diagnosis that we don’t even have a proper word for it, and to completely expunge a diagnostic label from the medical notes seems to require the computing equivalent of a can of engine grease.

My patient, however, had changed his lifestyle such that he no longer fulfilled the diagnostic criteria for diabetes. Deleting the diagnosis was the right thing to do and would reduce his health anxiety, along with his insurance premiums and the need for check-ups—so why should this action damage my practice’s profile?

The reason is that general practices are now subject to target rates for diagnoses, a new phenomenon that is central to NHS England’s dementia policy, and each clinical commissioning group and general practice in England was set a target at the end of 2013. In raising concerns about this policy last April in The BMJ1 I …