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GP training should involve psychiatry placement, BMA says

GP trainees should undertake an attachment in psychiatry to address the problem of neglected physical health in people with mental illnesses, the BMA has said.

The BMA’s ‘Recognising the importance of physical health in mental health and intellectual disability - achieving parity of outcomes’ report, published this week, estimates that 60% of avoidable mortality among people with mental illness is due to physical ill health.

It adds that men with mental health issues have their life expectancy shortened by around 20 years on average and women by around 15 years.

This follows the RCGP’s call for GPs to training alongside psychiatrists to improve the management of mental health conditions in children.

The BMA report claims the problems are compounded by recent cuts to mental health funding, with 1,711 mental health beds closed since April 2011, and therapy limited to just 20 sessions on the NHS.

The report says: ‘General practitioners in training should spend an attachment in psychiatry, liaison psychiatry, or intellectual disability. This is an area for action for the Royal College of Psychiatrists and the RCGP.’

It adds: ‘Achieving parity of outcomes between mental health, intellectual disability, and physical health is complicated by gaps in training and workforce planning: these are apparent during medical school, the foundation programme, and speciality training.’

‘A better understanding of mental health and intellectual disability, achieved through training at all stages of a doctor’s medical career, holds the potential to raise doctors’ aspirations for these groups while at the same time improving access to, and the quality of, care for mental health and intellectual disability patients.’

Professor Sheila Hollins, chair of the BMA’s Board of Science, said: ‘It is deeply concerning that mental health in the UK is not universally held in the same regard as patients’ physical health, nor does it receive comparable levels of funding.’

‘There would be an outcry if patients with a physical illness were denied treatment or care due to cuts in funding, yet this is what we are seeing for those patients suffering from mental illness.’

Pulse recently revealed the impact of new NHS guidance which told commissioners to cut non-acute services, like mental health, by 20% more than acute sector services. An investigation found that 77% of CCGs were applying 1.8% cuts to their child and adolescent mental health services, despite GP concerns that services are already overstretched.

Readers' comments (11)

  • Why do we have GP's and psychiatrists anyway?
    Surely a doctor should be able to manage both situations and not have a system that works with the psychiatrist working form the neck up and the GP working from the neck day!
    When will the NHS realise that the head are body are attached?. Patients suffer severe discrimination once they are known to use mental health services, and once in the system, their is no escape. Patients should be treated a s a whole, this would help avoid the stigma and discrimination that most mental health patients suffer.
    If you have a heart problem you may see a cardiologist but remain under the care of the GP, if you have a mental health problem, GP's and mental health care are divorced from each other ... mental health care really needs a revolution!

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  • Sorry but NHS psychiatry has been lost.

    Due to new ways of working medically unqualified people such as social workers and routinely conducting new patient initial assessments, nurses often gatekeep admission to the ward (I'm not joking - Consultant psychiatrists need PERMISSION to admit someone!) and so forth.

    This battle has been lost.

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  • Hazel Drury

    Hi Shurleea. I think you do a disservice to myself and my colleagues who find that at least 30% of a typical list of patients involves psychiatry. Psychiatry is at the core of my workload every day and thus most GPs know an awful lot from simple on the job training.
    I was a career psych before becoming a GP and am now section 12(2) approved like many GP colleagues.
    The thing is we are all generalists as GPs and cannot be expert at everything. some GPs like myself will retain a special interest in psych whilst others will be better at cardiology.
    To say that the 2 specialties of general practice and psychiatry are divorced is simply not true :-)

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  • I used to work with people with learning disabilities.
    To serve an entire community, a GP should learn from an entire community.

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  • Hazel Drury

    I think you hit the nail on the head there by saying A gp. A gp is not ALL GPs.
    I often have patients with LD brought to see me by well meaning carers with a massive chip on their shoulders over a bad experience which is then projected onto me.
    A little more education on both sides perhaps from where each party is coming from would probably help without losing sight of the person in between - the patient. All single issue groups want GPs wo be specialists in their particular field it seems. If we had to do 6 months training in each specialty it would take about 10 years post doctorate to qualify.
    I did psych for 2 years post grad. The training posts in learning difficulties and child psych only came to those who already had MRCPsych part 1 (i.e. registrars at the time) so GP trainees were never offered these sub-specialities anyway.

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  • More comments from "other healthcare professionals" who have no idea what general practice is about.
    Why are they even looking at this website?
    To say "why do we have GPs and psychiatirists" is like asking why do we have GPs and colorectal surgeons or any other specialist for that matter.

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  • 7th May 5:30pm - your comments arent fair
    Maybe 40% of everyone who comes in to see a GP has some kind of mental health issue going on ... mental health and physical health are intimately interwoven ... every GP knows that - you couldnt be a GP without grasping that basic simple fact. I personally did a year of specialist training in psychiatry before starting training as a GP - GPs get exposure to psychiatry every single day of the week. The trouble is that there just arent enough Psychiatrists (there plenty of cardiologist hey)...but there's a national shortage of Psychiatrists...they cant recruit them (GPs are going the same way)...maybe this is more about replacing Psychiatrists with GPs because increasingly no one ever gets to see one (a psychiatrist that is)?

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  • Hazel Drury: thank you you are quite right. I did not hold against the GP who made a derogatory comment about working with LD patients against all GPs but acknowledge that there are those who do.
    As it happens, I had a good chat with the GP involved and he was willing to learn, I was willing to look at how we could change our practices to make his job easier.
    It comes down to willingness to learn and willingness to communicate, two things which can be suffocated in the present climate.
    I don't have a problem with GPs but I think the profession needs to stop tilting at windmills and prioritise their militancy where it can do some good.

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  • Working in both secondary & primary care psychology services I am a member of various professional websites. I look on this website because my practice model is multi-disciplinary.

    Psychiatry is not lost, it is very much alive. Nurses have to work within a budget and manage beds accordingly, this means monitoring admissions and gatekeeping. Assessment are done by a variety of professionals, including Dr's who have the appropiate skills.

    Lastly in answer to the first comment, GP's do not have the time to work with complex mental health. Secondary care is designed to work with multi diagnostic mental health & forencic presentations and can apply the MHA for inpatient within their systems. A patient in the midst of a psychotic episode self harming would take up a full days of appointments in primary care.

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  • Every specialty should spend some time training in general practice!

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