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.