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GPs told to refuse requests to manage eating disorders

GPs are increasingly required to handle patients with serious eating disorders beyond their competency, GP leaders have warned.

Bringing up the concerns, two Welsh LMCs argued that the issue was not only a case of workload dump from secondary care but could also impact on patient safety, and are advising GPs to refuse the work.

Bro Taf LMC vice-chair Dr Steve Davies said that a drive by Cardiff and Vale University Health Board (UHB) to transfer certain eating disorder services to primary care was outside of the GMS contract as well as GPs’ comfort zone.

He said a recent case included a GP who made a referral to the health board’s high-risk eating disorder service but ’got a reply asking the GP to do investigations like blood tests and an ECG, and monitor patients at intervals while they were waiting to be seen by a specialist’.

He said: ’GPs don’t generally have expertise in eating disorders. Someone who is severely underweight may have complicated changes happening to their body, and a GP may not be able to manage them. It isn’t safe asking a GP to do this…

‘There’s a clinical governance risk that some investigations might not be done. The responsibility for this work should rest with mental health services. Another thing is that GPs don’t have the resources for this work. It doesn’t just mean money, but it takes time and you may need a specialist nurse.’

Dr Davies said that the LMC is open to discussions with Cardiff UHB about introducing an enhanced service, as long as GPs are ‘adequately trained and suitably reimbursed.’

North Wales LMC chair Dr Eamonn Jessup said that in his area, the health board was in some instances expecting GPs to monitor patients and carry out weekly checks.

He said: ’The onerous workload and lack of money coming with this is ridiculous. They are piling services onto primary care even though it is in a state of crisis in many parts of North Wales. In North Wales it would seem once again that our secondary care colleagues seem to lack the full understanding of how busy and overstretched we are in primary care now. Weekly checks are way beyond anything we could offer.’

But a spokesperson for Betsi Cadwaladr University Health Board in North Wales said: ‘We are not aware of any changes, nor of any concerns being raised by GPs regarding this.’

Cardiff and Vale UHB did not respond to Pulse’s requests for comment.

Readers' comments (15)

  • We received requests to be involved in the detailed assessment and management of patients with eating disorders and the reason given was that the service didn't have access to a specialist medical practitioner. I have put out reply below, feel free to adapt and use as appropriate.

    Thank you for your letter requesting our involvement in the detailed assessment of _____’s eating disorder. We would like to respectfully remind you that general practitioners are generalist physicians and whilst we have experience over a breadth of medical areas, we do not have in-depth expertise, including the assessment and management of patients with eating disorders.
    We refer you to the Guidance for Commissioners of Eating Disorder Services published by the Joint Commissioning Panel for Mental Health published October 2013 (co-chaired by the Royal College of General Practitioners and the Royal College of Psychiatrists), where clear guidance is given on what constitutes an acceptable community eating disorders service in terms of services offered. The content of your letter indicates that the local eating disorders service does not fulfil some of the basic requirements for such a service as outlined in the above document. Unfortunately, we are not in a position to provide non-commissioned specialist assessment and management of patients with eating disorders. Respectively, therefore, we decline your request to assess and manage the patient as per the content of your letter and request that you contact the patient to this effect and that you make alternative arrangements in collaboration with _____ Clinical Commissioning Group to provide appropriate full specialist assessment and management of this patient and their medical problem.
    Yours sincerely,

    Extracts from the above guidance.
    Eating Disorder Services for Adults (p.14)
    Anyone with an ED in England should have access to a comprehensive multi-disciplinary ED service.
    A community ED service should be able to provide the following:

    • Comprehensive psychiatric assessment to include ED psychopathology and identify comorbid mental health and physical conditions. Diagnosis should be discussed with patient, carer and referrer.

    • Risk assessment, both psychiatric and physical. This will include organising relevant investigations (e.g. blood tests, ECG, bone densitometry). Clear arrangements should be made with a patient’s GP agreeing responsibility for ongoing physical health monitoring. (As with any patient, as general practitioners, we are willing to be involved in reasonable non-specialist shared monitoring of patients after an initial comprehensive assessment by the specialist has occurred and after a specific management plan has been individually detailed for the respective patient).

    • Nutritional counselling and psychoeducation.

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  • re 5.52 such appalling ignorance is part of the reason youngsters are being shunted is a highly specialist CONDITION WHICH MOST gpS ARE NOT QUALIFIES TO DEAL WITH THE only thing BRO Taf is concerned about is funding.

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  • Dr Cardigan 5.52

    I do hope you and your patient(s) are not a disaster waiting to happen

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  • Standard behaviour in Lancashire. 2 weekly bloods stop gap appointments until patients hit crisis and have to be admitted. More worrying is the increasing requests for ecgs thinking presumably being if normal that the risk of sudden death is reduced..... it isn't its a false reassurance. I particularly was offended in the case of a dangerously underweight patient by a line in an outpatient letter stating "the physical health of this patient remains the GP's responsibility. Missing the point and passing the buck.The physiological problems being directly a result of the eating disorder. Whilst I'm always prepared to look after my patients medical needs I like my collleagues feel most of the monitoring to be pointless time and resource consuming unless there is active engagement with services. Trea the patient and not the test results.

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  • With several decades behind me of providing psychotherapy to people afflicted by eating disorder, it is extremely worrying that a number of Mental health Community Teams have had their funding reduced. This has lead to many more admissions which is costing the tax payer significantly more than it would have done, if the teams were better staffed. Early intervention is key. Therefore I am exploring the possibility to provide training for GPs and in particular their clinical staff on how best to respond to a referral.

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