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Consultants to advise GPs on patients who fail mental health referral criteria

GPs are set to receive personalised care plans from consultants for patients who do not meet the mental health referral criteria, as part of a new pilot.

In an email seen by Pulse, NHS Basildon and Brentwood CCG told local GPs that Essex Partnership University NHS Foundation Trust (EPUT) is piloting ‘a new approach to the screening of GP referrals’ to mental health services.

The screening programme will see a consultant psychiatrist review all GP referrals and create a ‘management plan’ for patients, ‘which do not meet the current criteria for treatment within secondary mental health services’. 

The email explained that the reviewing consultant will decide on the 'most suitable clinician to see the patient or will write back to you with a suggested management plan'.

However, BMA GP Committee prescribing lead Dr Andrew Green said: 'I doubt that there can ever be enough information in a GP letter, however much care is taken, for a psychiatrist to properly assess that patient’s risk, and to form a medical opinion regarding the best management based on information gathered by a third party is unlikely to meet basic standards of clinical safety.’

He added that ‘the clinical risk will rest in the GP’s lap, even if they have attempted to get specialist help’.

Dr Milind Karale, EPUT executive medical director, said: ‘If a referral is not accepted by the service, the consultant is best placed to make appropriate recommendations to the GP regarding the treatment of the patient.

'We also believe that the GPs are likely to have greater confidence in decisions made by the consultants. The request for such a pilot had come from local GPs.’

EPUT told Pulse that the pilot, which started last month, will run for three months before undergoing a review.

This comes after the Government announced it would be trialling a new four-week waiting time target for children and young people referred for mental health treatment by GPs.

Pulse revealed in 2016 that 60% of GP referrals to child and adolescent mental health services lead to no treatment and a third are not even assessed.

Readers' comments (18)

  • Refer, re-refer, catastrophise and shout! This will continue spiral until all involved will be either deaf or dead.

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  • @Francesca
    'If GPs have good suggestions let's hear them'

    Silly attitude (sorry I have to be blunt).

    We are supposed to be working together. It is not up to GPs to give good suggestions on how to improve mental health services after prolonged period of underfunding.
    GPs can critically analyse suggestions, this does not mean that they are fighting with their hospital colleagues.

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  • I had a nice liason psych letter whose main plan for a patient the complex depression team has finished with was ‘GP to see patient weekly’, presumably in perpetuity.
    I declined.

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  • I am extremely cautious about secondary care advice for anything. It is often evidence-light work-heavy and dubiously informed. Having to do the work yourself rather focuses the mind. My rule of thumb is if talking to a consultant colleague, it is either to refer or to ask a very focused clinical question.

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  • Peter Swinyard

    I think the answer is venlafaxine. Doesn't matter what the question is.
    Or some very nasty and toxic atypical antipsychotic (should they still be called atypical when they are now typical?).
    CPN visits?
    Reading the referral letter seems beyond some. Asking for specific medication advice? See para 1.
    Where are the wonderful shrinks who would cheerfully embark on some unconventional mixture of Marplan and Mianserin to cure the really difficul depressives???

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  • Ah, but the Health Board does have to provide the service: refer them back to the Trust's Medical Director!
    Many actually do better cared for solely by GPs than seen by the CMHT anyway, possibly because CMHT no longer includes an assessment by anyone with a medical or psychiatric qualification most of the time, just non-medical 'practitioners' who like to recommend dangerous drugs to see what happens.

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  • We have seen through what is a broken health system where the failure to control demand and the funding and staffing is not matching the idealistic care. As a temporary pacifier to patients, they are scapegoating doctors and getting the specialist and GPs to fight. Well, no, we will tell the patients that is what they are getting for rationalised health care and "free at the point of use".

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  • Jones the Tie

    serious point _ unusual for me ..locally the CMHT have allocated each practice a 'primary Care Mental healthcare Worker' who does 2 sessions a week in the practice and can often see and advise us directly about what the best service might be for that patient and actually treat them as well. They have great links and access to all the CMHT and third party resources and have become a very valued member of our team. This has enhanced our understanding of mental health issues and reduced referrals to consultant colleagues. the role is provided by CPN/Clin psychology trained staff and is utterly excellent. Nobody gets irritated by 'refusals' as we do that odd thing of 'talking' to each other. I realise we are very fortunate but surely this approach is much better for the punters that consultants reading letters at a distance and making 'suggestions' . How about that as a suggestion Francesca? We are ALL working with reduced capacity and increased demand I'm afraid and we are ALL underfunded both fiscally and in terms of clinical resource . Surely CMHTs across the country need to start looking at their excellent staff and using them more pro-actively. lots of 'referrals' don't need to go anywhere the consultant psychiatrist as there are other staff with extensive mental health abilities who can quite adequately perform this role freeing up the consultants to see the patients who do have significant issues which can not be helped by other means. ?? any use Francesca

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