This site is intended for health professionals only

At the heart of general practice since 1960

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)

  • This sort of box ticking nonsense drives me almost as mad as the drivel containing letters describing why whatever referred patient does not need seen. Where does liability lie if someone comes to harm. I routinely copy the refusenik letter to the patient and hope they complain. Quite simply we do not refer without concern and app based and chatbot mindfulness is a patronising cop out. Just lets the downtrodden know that truthfully nobody actually gives a flying @@@@

    Unsuitable or offensive? Report this comment

  • The problem is the supply of doctors and the funding of mental health. You get what you pay for and for ages and ages what HMG and CCGs have paid for is fewer mental health doctors, fewer mental health nurses and fewer psycholigists other than IAPT.

    In this situation what should mental health trusts do ?

    Our organisation gets 18,000 referrals a year we have resources to see 4000 and to treat 1500.

    If GPs have good suggestions let's hear them.

    Unsuitable or offensive? Report this comment

  • "Our organisation gets 18,000 referrals a year we have resources to see 4000 and to treat 1500.

    If GPs have good suggestions let's hear them"

    Now gather around children. What you see here is a crumbling healthcare system causing doctors to throw anger at each other. Now children don't you think the logical and sensible thing for these doctors to do is leaving the country if working in the NHS makes them so angry?

    Unsuitable or offensive? Report this comment

  • AlanAlmond

    “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.”
    Urrr no. How can somebody who hasn’t even seen the patient be ‘best placed’ to make appropriate recommendations ..regarding treatment? Really ...how so? I’m gobsmacked at the utter stupidity of this statement. Self evidently total crap. The person best placed to make recommendations is the person actually clinically responsible for their care and the person currently seeing them. Until such time as a consultant has actually seen them they are just guessing and guess what hey hold virtually no clinical responsibility if the shit his the fan. How wonderfully convenient , cheep and utterly useless

    Unsuitable or offensive? Report this comment

  • 'Referral criteria" - seem to have crept into general acceptance.

    Another fact of life that make managing, bearing and holding uncertainty even harder. Another jeopardy in the making.

    Unsuitable or offensive? Report this comment

  • I think Francesca is spot on right. Mental health services have been underfunded into nearly non existence. I see no point in referring any more. Those who "meet criteria" find their way in themselves.
    As GPs what should we do about it?- tell patients how it is.
    So you wish to be referred a specialist service that can diagnose, advise on treatment, care etc? Eh... you see, in reality, you will fail to answer phone within one beep and will be triaged green/silver/whatever and discharged. At best you will be seen by a social worker or a psychology graduate, who will have no idea about questions in my referral. Consider saying that you want to kill yourself, or somebody else, this might get you further. Sorry, but we are all in it together. Next!

    Unsuitable or offensive? Report this comment

  • Bit there is parity of esteem with physical healthcare isn’t there? Surely? That’s what Hunt and Mrs May said didn’t they? Didn’t they?
    Fantasy parallel universe.

    Unsuitable or offensive? Report this comment

  • AlanAlmond

    i.e. consultants to send photocopies of NICE guidance to GPs when they don’t have the staff to see the patients they’ve been referred.

    ..see enclosed NICE guidance and/or relevant chapter in Kumar and Clark.

    Oh thanks, nice one

    Unsuitable or offensive? Report this comment

  • AlanAlmond

    Dear consultant , I’ve got this patient, they are a bit of a handful, I’ve got a pretty good idea what needs to be done but neither the time nor resources to do it, please help

    Dear GP, thanks for your referral, indeed this one is a bit of a handful, we too have a pretty good idea what needs to be done but like you we don’t have the time nor the resources to do it, what we do have though is something called ‘referral criteria’ which means we don’t have to. I’m enclosing a leaflet I printed off NHS choices, your on your own sunshine, laters.

    Unsuitable or offensive? Report this comment

  • Dear Consultant: Why don't we just work somewhere which does have the time and resources?

    Dear GP: Good idea

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say