GPs ‘should get bonus’ if they spot stroke risk

But critics say checks are just routine

GPs should be paid extra to detect a heart condition causing 8,000 avoidable strokes a year, the NHS watchdog has said. NICE wants GPs to be offered incentives for spotting and treating the common disorder atrial fibrillation.

The watchdog is concerned that GPs are either missing the condition or failing to prescribe life-saving drugs which cut the risk of stroke by 70 per cent.

But critics were dismayed at the suggestion that doctors need a financial incentive to perform basic tasks.

Up to 1.5million Britons are estimated to have atrial fibrillation, but almost a third have never been diagnosed.

The condition causes an irregular or very fast heartbeat, which increases stroke risk five-fold and can lead to sudden death.

It can be detected by checking a pulse and treated with warfarin, which prevents blood clots and strokes, at a daily cost of £1.

NICE has produced recommendations to ensure the condition is diagnosed and treated.

It said too many had ‘slipped through the cracks’, adding that proper care ‘can be the difference between life and death’.

NICE wants the condition to be included in a bonus scheme for GPs introduced by Labour a decade ago, the Quality and Outcomes Framework.

This sees them earn points, equivalent to cash, for monitoring and treating conditions including heart disease, asthma, epilepsy and even obesity. The watchdog wants GPs to be offered money for each patient with atrial fibrillation identified as being a high stroke risk.

They would receive more cash for every patient prescribed warfarin. NICE’s recommendations will now be considered by NHS England, which will decide whether the bonuses should be rolled out and their value.

Atrial fibrillation is often referred to as a silent killer, as most never realise anything is wrong until they suffer a stroke.

NICE estimates almost half a million Britons are living with the condition undetected.

The watchdog is urging GPs and nurses to check patients’ pulse during routine consultations including appointments for repeat prescriptions or the flu jab. It is also concerned that GPs are failing to prescribe the warfarin. Some fear the drug will cause serious complications and prefer to prescribe aspirin, even though it is far less effective.

NICE also wants local NHS managers to collect data on surgeries’ diagnosis rates and prescriptions.

Professor Danny Keenan, associate medical director at Central Manchester University Hospitals, who is part of NICE’s advisory committee, said: ‘It is only with data like this that we can properly assess the steps we need to take to ensure no-one at risk is left unchecked or untreated.’ The watchdog did not specify how much GPs should be paid for each patient, which would be for NHS England to decide.

If approved, the recommendations would be rolled out by Spring next year at the earliest.

Mark Littlewood, director general of the Institute of Economic Affairs think-tank, said: ‘It is baffling to suggest that GPs should be paid more to carry out such simple, yet life- saving procedures when it would be reasonable to expect that these check-ups are part of their job description.

‘Given that the NHS is currently facing severe financial constraints, it is ludicrous to consider paying GPs more to carry out a job they should already be doing.’

Jonathan Isaby, chief executive of the TaxPayers’ Alliance, added: ‘GPs are already very well paid compared to their international counterparts so it’s difficult to see how more money just for doing the job could be justified.’

A study by York University earlier this year concluded the bonus scheme had not prevented any deaths, and may have led to poorer care for conditions such as cancer.

Around a third of GPs’ average salaries of £100,000 a year is comprised of the bonuses.

NICE estimates that improving detection and treatment of atrial fibrillation, which causes a fifth of all strokes, could save the NHS £95 million.

‘Too many have slipped through’