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GPs forced to diagnose mental illness in children ‘outside their competence’

Exclusive The majority of GPs say they have to diagnose child and adolescent mental health disorders ‘above their level of competence’ due to a marked deterioration in access to specialist services.

Six out of ten say that they are forced to diagnose serious illnesses such as autistic spectrum disorder or ADHD and prescribe specialist treatment, due to a ‘dearth of provision all over the country’.

The Pulse survey of over 900 GPs found 47% believed access to child and adolescent mental health services (CAMHS) had worsened in the past year, compared with only 5% who believed they had got better.

Some 58% of respondents said they are expected to diagnose child and adolescent mental health disorders due to a lack of access to services, compared with 36% who said they were not.

The figures come as an independent report - published today - found that between 2013/14 and 2014/15 the number of referrals to CAMHS increased five times faster than the growth of the workforce in these services.

The Mental Health Taskforce report recommendedthat the £1.4bn committed for children and young people’s mental health over the next five years should be invested to ensure that by 2020 at least 70,000 more children and young people have access to high quality care. 

But the investment comes after successive cuts in CAMHS budgets. A Pulse investigation in 2014 revealed CCGs were making cuts of around 1.8% to their CAHMS budgets.

Last year, a NSPCC investigation found that one in five children and young people were rejected for treatment and that waiting times were up to six months. And now GPs warn this has resulted in them feeling pressured to diagnose and treat patients beyond their generalist training.

Last year, Scottish LMCs claimed GPs were increasingly being expected to manage patients on specialist treatments, such as sedatives and tranquilisers.

This new Pulse survey shows this is the case across the country. A female GP from Yorkshire said diagnosis was ‘often expected by patients in general as there is a lack of specialist services for GPs to turn to for advice or assessment’.

A male GP from Scotland said: ‘I am pushed to refer many children who are badly behaved, have educational rather than mental health issues, and who are being harmed by poor parenting skills. I am really not qualified to intervene in any of these areas and would like to have a service I could refer vulnerable children to, at least until a diagnosis is made.’

A female GP from Norfolk said: ‘We’re often feeling pressured into prescribing SSRIs to adolescents because wait to see anyone is unacceptably long.  Yet, I feel that this is a specialist area.’

A portfolio GP in West London said: ‘Referral to CAHMS, etc are being rejected, and new, stricter referral criteria being imposed so that GPs are expected to diagnose and treat much more.’

GPC prescribing lead Dr Andrew Green said: ‘This age group often demonstrate their distress by behaviour problems and there is understandable pressure from parents and schools to have diagnoses made as soon as possible. However, conditions such as ADHD or autistic spectrum disorder require detailed assessments which GPs have neither the skills nor time to provide, and huge damage can be done by premature or inaccurate labelling of children and young people.’

The RCGP has recently called for a mental health worker to be provided for GP practices to ensure access at all times to specialist support.

An NSPCC spokesman said: ‘These figures underline the considerable problems there currently are in local mental health services. GPs play a key role in helping to support extremely vulnerable children, including those who have suffered abuse and are struggling with the severe consequences on their mental health.’

What are GPs saying?

Do you feel you are expected to diagnose child and adolescent mental health above your level of competence due to a lack of access to services?

Yes - 58%

No - 36%

Don’t know - 6%

 

Over the past 12 months, has access to child and adolescent mental health services in your area:

Greatly improved - 0.3%

Improved - 5%

Stayed the same - 43%

Worsened - 35%

Become much worse - 11%

Don’t know - 5%

The survey was launched on 26 October 2015, collating responses using the SurveyMonkey tool. The 20 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to readers via our website and email newsletter, with a prize draw for a Samsung HD TV as an incentive to complete the survey. A total of 922 GPs answered this question.

 

Readers' comments (11)

  • More and more parents want their children to be labelled with a mental health problem when in reality all they have is a behavioural problem. We need to tackle this first.

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  • Act outside your competence and you won't have a leg to stand on in court.

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  • The incidence of autism and people on the autistic spectrum are increasing dramatically. I have now seen many autistic children whose diagnosis is even missed by consultant paediatricians!
    I see so many children now with these issues and their symptoms are real but you have to recognise them to make a diagnosis and if you don't ask the right questions, you will not get the right answers.
    Also these diagnoses and assessments take time to make as mentioned above. Few will achieve this in 10 minutes.

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  • Most GPs act outside their level of competence in all specialities. On survival ---protect yourself first and foremost not the 'UNDERFUNDED NHS'-- REFER REFER REFER.

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  • Anonymous | GP Partner15 Feb 2016 8:15am

    Exactly. If it's outside your competence then don't do it. Refer to hospital and if they write back saying no service available then pass this to the parents and let them take it up as a complaint.

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  • Vinci Ho

    No exaggeration to say this government has turned NHS into a Dystopia.....
    1984
    Hunger Games
    Divergent series
    Maze runner series
    The Walking Dead series
    Of course, GOT......

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  • John Glasspool

    Well, personally, I was not above starting a teenager on a SSRI if I was certain they were depressed, whilst awaiting assessment but I would NEVER have put a child on Ritalin, for example, without expert advice. Our local CAHMS (Southampton) went through a very good phase when a sort of face-to-face triage was carried out by experienced Health Visitors who had had extra training. They were good at referring on the kids that needed medical help and signposting for those that didn't. Then some cockwomble(s) (who??) decided to "improve" things and we then went to a "service" whose main function was to paper triage and then reject almost all GP referrals.
    SO glad I am out of it. Bit of a minefield now, I think.

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  • 'A male GP from scotland' has hit the nail
    On the head. Lots of social problems all wanting to be fixed with a 'diagnosis'. So the system is flooded. Quite oftern behavioural problems which the school should deal with come my way with an expectation of referral and diagnosis of ADHD as the school gets more funding for the child. This is where the pressure to diagnose comes from. We're on a loosing wicket.

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  • We GPs are dealing with all manner of diseases way outside our remit and expertise, because there is o one else at all. Early discharges, blood tests, medical and surgical conditions way beyond our expertise.
    I just do not know how the courts/ GMC look at cases such as these. It is like a good Samaritan clause.
    Best I can do, as there is no one else.

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  • ADHD is unneccessary medicalisation of poor behaviour. Giving ADHD kids drugs is completely immoral. The parents of ADHS kids don't need more money- they need parenting lesson. Is there any wonder we have flopped this one?

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