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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 are not aware of any changes, nor of any concerns being raised by GPs regarding this.’
    the phrase says it all.

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  • A Young person with years of eating disorders has yet again been transferred from Vale of Glamorgan S Wales by Bro Taf - to a unit in the Midlands- she has previously been sent to Bristol and other regions in England the services provided in Wales stink.what they are mainly concerned about is money and to hell with the individual and her family

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  • Like the poster at 5.30pm, I've experienced the lack of local provision for the management of people with severe eating disorders, not only as a GP but also as the parent of a young person who had anorexia nervosa. We live in Cumbria; when an inpatient bed was found for my daughter it was in the east of Scotland, and we discovered that a seventeen-and-three-quarters-year-old person with a serious mental health problem in a CAMHS unit becomes a hot potato, with discharge rather than recovery being the priority.

    Organising blood tests and doing ECGs in anticipation of the results being available to the secondary care practitioners who see the patient the following day is one thing. (These tests are usually normal, give or take a sinus bradycardia, which doesn't mean that the patient isn't precariously ill.) Agreeing to monitor high risk patients in order to allow the secondary care service to make a less urgent response is another matter. We don't have the time, the expertise, or the facilities, and we should certainly refuse all such requests.

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  • Dear Specialist:

    Thank you for your acknowledgement of my referral.

    Unfortunately I am not in a position to provide the monitoring you request before this person is seen by your department because to do so would require me to work significantly outside my competence, and without resource.

    I must therefore insist that all such monitoring is carried out by professionals whom you have specifically trained and authorised, and who work under your own clinical supervision.

    Yours,

    GP

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  • This is standard behaviour by secondary care in my area (SE England). Weekly weights ECGs and bloods.

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  • Dear Colleagues, please choose where you decide to take offense with a little more consideration. Monitoring these disorders is essentially HCA appointment for weight, bloods +/- ecg and an update from the family. If you really think that specialist can do it better, by all means , be as obstructive as you like. Practicing outside the scope of one's competence is not a concern here because there simply isn't much "competence" about this group of disorders in all levels of care. A bit of common sense to identify those in need of admission is all that's needed. I am not aware of any real evidence that secondary care interventions are any better than passage of time and basic psychological support. With a fairly non existent mental health services for youngsters, it would be very concerning if we began to refuse providing this basic monitoring. Filling gaps across many services is nothing new for GP.

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  • " Filling gaps across many services is nothing new for GP. "

    Unfortunately we have reached our limit. With no more resources we cannot continue to absorb this work as it threatens the care of our other patients.

    When patients no longer have a GP and have to go to A+E for any episodes of care the NHS will fail, and great harm will be done to many patients.

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  • To 5.52pm

    "Monitoring these disorders is essentially HCA appointment"

    ... What else do you let your HCAs manage?

    Safety first. Safe care first. Trying your GP hand at whatever specialisms you fancy is inherently unsafe. Your lack of insight as to the competences required to manage the fundamental risks of these disorders in under-resourced primary care is troubling.

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  • Dr Cardigan 5.52:

    You think it's ok to employ a HCA out of your own pocket to cover gaps in service by secondary care?

    Besides which, what these people need is not blood tests it's to start talking about it.

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  • Anonymous | GP Partner06 Mar 2016 5:52pm


    and this is why we're being dumped rubbish from secondary care left right and centre.

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