Is it true that gp’s are given bonuses or monetary incentives to prescribe certain illnesses?

[Hoppl]

Illnesses such as depression, diabetes, asthma, anxiety. I just read this in a daily mail article (sorry, I won’t link). It was saying that there is no incentives for drug companies to encourage doctors to look in to menopause and treat low hormone levels. As the drugs for this are cheap in comparison to the drugs to treat the symptoms such as depression.

I have heard such things being said elsewhere. Also, I remember when I was young the doctors would badger me every time I saw them about something else telling me I should get a smear test. No matter how many times I told them I didn’t need it as I wasn’t sexually active. They sent out letter after letter to my parents address, I found it so embarrassing I eventually booked to get one done just to stop the letters. Then I heard later there were doctor incentives to get a certain percentage of women to go for smears. Anyway, I digress. Just wondering if these incentives really exist

Yes surgeries get points for hitting certain targets and points convert to money.

I suppose with the smear thing...if they code you as not needing a smear you wouldn't get reminders if the situation changed so there's no real way of taking off the prompt that gets you invited for a smear. If you'd had a hysterectomy for example they could permanently get rid of that prompt iyswim

Yes they do if you mean the QOF (quality and outcome framework)

This isn't anything to do with Big Pharma, but rather an incentivisation scheme to make sure there is reward for carrying out routine preventative work, such as screenings and immunisations and things like finding time for checking in with patients with longterm cibdituins such as cancer. It's been in place for quite a while and is I think part of the GP contract

Thanks for replies. I didn’t really think that necessarily was a big pharma thing, I understand that is a bit far fetched. But I think the article was implying the surgeries are kind of unwittingly supporting drugs for expensive treatments like depression when perhaps it’s worth looking at the whole picture and what may be the cause.

It's a target to ensure good care is given.

The incentive to ensure all patients with asthma get annual asthma reviews, because patients who have annual reviews are less likely to have an asthma crisis of some kind.

It incentivises prevention instead of crisis intervention.

If you know 5% of the population need treatment x, and only 1% of a surgery's patients get treatment x, you need to explore why. It could be because of the demographic. It could be because of an unknown factor that needs more investigation. It could be because that surgery's doctors are crap at recognising the condition that responds to treatment x and so their patients are missing treatment.

So there are targets to get patients treatment and check ups for certain conditions. But are there incentives to actually diagnose certain conditions? Such as depression or anxiety?

I apologise I do t mean to stir a hornets nest or be argumentative. I am just curious how it works

I have worked in big a Pharma and how we could reward Doctors was very very tightly regulated (although there were ways round it) so they can’t actually pay in return for prescriptions.
However, I believe GPs are targeted by the HA to treat certain conditions and/or to have a certain percentage of the Practice to have had smear tests or flu jabs for example
So no Big Pharma conspiracy and in fact it was usually Doctors who would ask me to break the rules (which I could have been fired for)

Personally I think there are better questions like whether women's health issues are seen as emotional or psychological in origin and treated indirectly (antidepressants) whereas men's are seen as mechanical and needing direct treatment.

I also see far too many women on antidepressants because their husband is behaving like an arse because he should be on antidepressants!

But that's by the by!

Agree - what pharmaceutical companies are allowed to do in UK is tightly regulated (it's totally different in the US for example)

A GP will probably never need to buy pens or post-it notes again, but incentives larger than that just aren't allowed

(disclaimer - knowledge based on the amount of stationery someone used to bring home!!)

I expect being nhs you are right that there won’t be a strong link between big pharma and doctors. I remember recently taking my son for eye test at opticians and feeling a bit uncomfortable before we went that the optician had a financial incentive to find a need for glasses. It did make me think that it’s good doctors don’t operate like that. I was wishing there was a nhs optician which operated separately from the place that sells glasses and just wrote prescriptions. (Incidentally it was find optician was not dodgy)

But do doctors get incentives for diagnosing certain conditions. Ones which perhaps are seen as underdiagnosed? So nhs sees it as an necessary to make sure doctors are considering these conditions ?

I think you have a good point picklemewalnuts .

Opticians prescribe glasses that patients don't need? I'm pretty sure mine doesn't. She tried to talk a relative out of getting glasses as she said the improvement they'd give would be miniscule.

Yeah I was overthinking the opticians.

I work in a hospital. In the A and E patients need to be seen in a certain amount of time and if they wait over, say 4 hours, then we g we fined. Not personally, the ward, so the already struggling NHS budget is further cut.
I’m sure the GP has something like this. To ensure he isn’t slacking and is ensuring the crippling mental health teams are supported by him talking and offering medication before people reach crisis, the cancer programme has targets of 6 weeks and 12 (?) weeks that with such a backlog of people it’s impossible to reach, so smears again will catch pre cancerous cells and reduce that.
It’s not a ploy to make money, like the “social workers get paid to steal your babies”.

I don’t really think it’s a ploy to make money. Just more of a box ticking exercise that isn’t necessarily in the patients best interest. I am not really explaining myself well. I just like to think the patients best interest are at the heart of the decisions.

I think this:
If incentives make them do check ups that catch illnesses at an early stage, that a good thing.
If you had an illness, you'd want a doctor to diagnose it even if no treatment were necessary. If incentives did this, it's a good thing.
No doctor is going to diagnose you with something you haven't got for some money.
No doctor is going to not diagnose you with something because they don't get an incentive.

Basically, incentives can only benefit the patient.

@Hoppl

I don’t really think it’s a ploy to make money. Just more of a box ticking exercise that isn’t necessarily in the patients best interest. I am not really explaining myself well. I just like to think the patients best interest are at the heart of the decisions.

You need to pluralise your last statement to get closer to understanding....

It's what's in the best interest of the patients

All of these incentives are decided at a central government / public health level - for example, if they know 93% of children need to be immunised to prevent a measles pandemic - they'll set a target that takes that into account with an anticipated level of failure - i.e. set the target at 95% or 100% to achieve that aim.

Same for smears - the infrastructure - i.e. testing appointments, nurses, lab time, pathologists etc is a fixed cost, there'll be a target that is designed to make the screening program cost and disease-prevention effective, which sometimes necessarily ignores an individual.

Most (if not all) of these payments are based on a bulk contract rather than individual patient, i.e. incentive (£) x no. eligible patients once the target is hit, which often means it's all or nothing - so if they make individual exceptions and then as a result fall below their target, they may get none of the best practice or QOF uplift for that condition, which can massively hit the practice financially.

That makes sense fixthebone. It’s just good to understand how these things works. I had no idea when I got all these letters what was behind it, if the doctors had explained they were trying to meet targets, I would have understood better. I assumed there was an individual benefit to me somewhere and that although cancer risk was low was not impossible. I had no ide they weren’t really looking at it from my benefit point of view at all.

I'm not sure they can even give out pens & post it notes now!

Oddly enough, I've had 2 diabetic reviews cancelled at short notice (one actually when I was sat in the waiting room) so haven't had a blood test or medication review for 2 years now.

I looked online the other day at my medical record and it appears I've magically had a review.... they've entered my height, weight, and BP readings............ so I'm assuming that they're claiming the money for it. Never mind my kidneys could be failing as long as they're getting paid. I've a good mind to complain to the practice manager.

@Cookerhood

I'm not sure they can even give out pens & post it notes now!

They can still give things that are to be used within The Practice that is worth under a certain amount (can’t remember what)

Oh that’s bad boodlebug you should definitely complain.

I didn’t know it was possible to review records online??

It's QOF and they may also have local targets with their CCG.

It changes all the time based on what is seen as a priority.

@BoodleBug51 that could be fraud. The (privately owned) practice could be claiming public money for checks they haven't done. This puts patients at risk and and the practice earns money fraudulently from the NHS. Please report this to the NHS Counter Fraud Authority on 08000284060 or fill in their form online cfa.nhs.uk/reportfraud . The practice has nothing to fear if this is a mistake or error on their part.

The qof uplift is money that was taken away from payments at the start of this system to be 'earned back' so its less of a reward for doing it and more of a punishment for NOT doing it if that makes sense ?