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Target diagnosis rates in primary care are misleading and unethical

BMJ 2014; 349 doi: (Published 02 December 2014) Cite this as: BMJ 2014;349:g7235
  1. Martin Brunet, general practitioner, Binscombe Medical Centre, Godalming, Surrey GU7 3PR, UK
  1. martin{at}

After the practice level targets for dementia, come targets for six other conditions. But the data they are based on are flawed, and this approach incentivises potentially harmful overdiagnosis, says Martin Brunet

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 …

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