'We need to step away from artificial targets' in Pulse, 7 November 2014
"As the lead of a new group tasked with examining the harms of
overdiagnosis, Dr Margaret McCartney (@mgtmccartney) tells Pulse reporter Caroline Price
why a wider debate is needed about the direction medicine is heading."
"Dr McCartney has wasted no time in using her platform on RCGP council to
take these concerns right to the top of the agenda. Since her election
to council last year, she has instigated the creation of a new standing group, specifically tasked with addressing these problems and giving GPs more support and professional guidance on how to deal with the conundrum in their daily practice.
creation of the group, she tells Pulse, has come out of growing
concerns from GPs that the Government is shifting the focus away from
those patients with the greatest need onto preventative measures for
healthy people, for which the benefit-to-risk ratio is far less certain."
"She says: ‘We’re interested in policies that drive over-diagnosis and
under-diagnosis – in particular thinking about prescribing practices,
guidelines and QOF and what could be done to try and help in those
‘We’re also thinking about practice day-to-day. How to make
good evidence-based decisions with patients in the stress of a
10-minute consultation – and quite often two or three problems from
patients. So, what kind of information we need easily on hand within
five seconds, to help GPs and patients make good decisions.’
Dr McCartney is also clear these problems are part of a wider debate to
be had with patients and in society in general, about the direction of
medicine and how best to use limited healthcare resources.
says: ‘I think it’s patients who deserve to know that the resources are
not going in the right direction at the moment and that we should be
redirecting it to people who are most likely to benefit.’"
"Similarly, Dr McCartney argues the controversy over policies to
incentivise GPs to screen for and diagnose dementia marks a watershed – a
time to ‘let go’ of targets and let GPs’ professionalism take
She says: ‘There is a revolution needed, we need to
step away from targets… that create deprofessionalisation of our work,
and let go.’
She adds: ‘Doctors are vocationally trained,
reflective people paying attention to the evidence… peer review, being
open about diagnosis rates, alert to criticism – that should be what we
are basing our practice on. It should not be the creation of artificial
[Read complete article]
Comment from Dr Peter J. Gordon (@PeterDLROW), Psychiatrist for Older Adults, NHS Scotland; 25 November 2014
"NHS Scotland had a financially incentivised approach to the "early
diagnosis" of dementia. This was HEAT Target 4. The target was reached
and the Scottish Government were triumphant about this presenting the
achievement to Westminster in 2012 (All Party Parliamentary Group)
Board in Scotland took robust measures to reach the target and thus
gain the financial reward. Practice became skewed in many ways to reach
This target was set by the Scottish Government. The
most Senior Official for Mental Health in the Government (Mr Geoff
Huggins) stated that the Government had been careful "to take out
saboteurs" and that any disagreement by doctors or managers would be
dealt with "behind the bike shed".
Wind on nearly 4 years and it
is emerging that elderly patients were mis-diagnosed with "early
dementia" as a result of this target. In fact they have static
age-related memory loss and not dementia.
Scotland stands as
evidence emerges of the harmful effects of an incentivised target based
on "early diagnosis". It is no light matter to make a wrong diagnosis.
Ask those mis-diagnosed.
I personally campaigned across the
United Kingdom for an approach based on a TIMELY approach to diagnosis.
This approach was completely rejected by the Scottish Government
throughout my "engagement" with them. But CURIOUSLY the Scottish
Government are now taking credit for a timely approach to diagnosis.
This is quite sickening as Scotland could have offered an important
lesson had the Scottish Government been open, honest and shown probity.
agree with all those who say that chasing a crude uncertain population
target, a target that is politically motivated and has been promoted
RELENTLESSLY by the Alzheimer's Society is UNETHICAL.
approach risks generating a huge amount of fear. It also risks
medicalising too much of ageing such that those living with dementia are
further disadvantaged as services get ever more stretched.
all a TARGET like this, and I realise that NHS England call it an
“ambition”, ignores complexity and the parabolic distribution of
cognition over our life course. Our elder generation deserve far far