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GPs acting as 'safety net' as council cuts child mental health services

A city council is looking to cut funding to a range of services including young people’s mental health treatment and smoking cessation, in an effort to balance its books following a slash to public health budgets.

Wolverhampton City Council said it is cutting counselling services for young people, to be replaced by school-based services that will help young people 'build resilience'

At the same time, it is cutting smoking cessation services and instead pointing people towards nationwide apps, as well as 'transforming' children’s weight management services, infection prevention and support for breastfeeding women. 

Local GP leaders have said the consultation document shows a ‘dilution of services’, while the cuts will affect GPs who will have to act as a 'safety net' for patients who use the service. 

The council claimed that savings were not the ‘driving force’ behind the restructuring, but the council papers say Wolverhampton is facing a £376,000 overspend at the end of the 2017/18 financial year.

Council papers for the next health scrutiny panel meeting on 25 January also add that the services changes, which are expected to be finished by the end of this financial year, are ‘necessary to balance the budget (since 2014/15 the public health funding grant has been cut by 17%)’.

The proposal suggests new smoking cessation services will focus on making ‘everyone aware of the self-help stop smoking tools and support available nationally’ such as the NHS Smokefree app and the NHS national quit line, as well as school-based support to prevent young people from smoking.

The council’s mental health services are also facing cutbacks with ‘one-to-one free confidential counselling’ in community and hospital based settings being replaced with school-based services that will ‘increase awareness and provide young people with the tools to build resilience’.

Dr Gurmit Mahay, medical secretary of Wolverhampton LMC, said the proposals would lead to ‘a dilution of services, and dilution of impact of the services’ and leave overstretched GPs acting ‘as a safety net’.

He said changes to the mental health service are ‘a concern’ and could see ‘patients who are already distressed being bounced around in the system and eventually pop back out and land on the GP’s doorstep’.

He added: ‘That doesn’t help the patient and it doesn’t help overstretched general practice.’

Dr Mayah said that he expects the cuts to smoking cessation services in general practice to cause ‘the rate of success drop’ as the service puts ‘the onus on the patient to pull down information’ on how to quit smoking.

The service changes come as the Government announced plans to cut public health funding by £170m over two years, with Wolverhampton set to lose over £1m by 2019/20.

Dr Mahay said that it was clear the council ‘is moving from being a provider to being an outsourcer’ in an effort to balance its budget.

He said: ‘So it’s no longer in the business of service provision, just service redeployment and signposting - signposting to other services, which I’m sure have got enough on their plate already, like the schools and the GPs.’ 

However, John Denley, director of public health for Wolverhampton City Council, said the public health services need to be restructured ‘irrespective of the finances’.

He said: ‘Data from the public health outcomes framework shows that the current public health approach isn’t having the impact we would have wanted for Wolverhampton residents.’

A continued decline in public health resources

The Government announced this month that it plans to cut public health funding by £170m over two years, with local authorities losing out on £85m in 2018/19 and another £85m in 2019/20.

It follows a major cut to public health budgets in 2015, when it was slashed by £200m amid a raft of measures to ‘bring down public debt’.

Recent research found that the 2015/16 cuts would cost around £1.6bn in the long run, because of the expected rise in teenage pregnancy rates, sexually transmitted infections, homelessness and suicide.

It immediately resulted in cuts to GP services, including six councils cutting their smoking cessation budgets by hundreds of thousands of pounds.

In the East Midlands, Lincolnshire County Council completely axed GP referral services for weight management and exercise as a result of Government cuts to public health spending. In Devon, the cuts led to some practices having to drop contraceptive services.

Following the cuts to the public health budget Dr Richard Vautrey, then-GPC deputy chair said GPs ‘would struggle to cope with any further cuts’.

Readers' comments (8)

  • Took Early Retirement

    Ah! The "resilience" word again- a sort of neologism for "we aren't funding this anymore".

    Mind you, I have always been quite a sceptic when it comes to "counselling". After all, it is just listening to people in its truest form. Looks like the PH doctor from Wolverhampton agrees!

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  • The same is happening in Lewisham where the Council is cutting funding for CAMHS. It too claims it is improving services. What I really don’t understand is why these Labour controlled councils keep justifying the Tory cuts by claiming that the cuts are improving services. Why don’t they tell the truth and say that the Government is slashing their budgets and they are having to make hard choices, including cutting some services, for which they are truly sorry as they know it will make services worse, but that the blame should be placed squarely on the shoulders of the Government? The electorate would understand and appreciate such honesty instead of the attempt to con them by saying that cuts improve services.

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  • Doctor McDoctor Face

    GP is the end of the 'food chain' dumping ground

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  • don't accept the implicit transfer of default responsibility then, unless there is a very punitive LES costing £1 per year more than the potential cost saving..!
    Every time GPs step forward to fill a gap, or even worse, fail to shout when services are cut, they undermine their position. We don't really have the skillset to do any Public Health stuff (otherwise the UK wouldn't have invented and established statutory Public Health Services).
    I went on an OOH home visit recently where an elderly lady had fallen, had some simple bruises and the "committee" of extended family, social services and the care agency sitting in the hosue waiting for me to arrive all decided that they were not willing to provide some short term extra supervision while her bruises settled. She needed help of 1 to stand and walk.
    It was quite telling that as each of these groups exercised their "right to refuse" there was an assumption that the GP / NHS would step in to admit this patient.
    In the strictest sense, her medical intervention should have been to assess, diagnose and formulate a management plan, and I could have made a case for "paracetamol, reassurance, short term increased supervision by family and care staff who are already engaged and aware of the issue".
    ..but for some reason it became "we have all decided that we don't want to play, you can assume responsibility for a safe outcome here, Dr.." Patient admitted after an increasingly blunt discussion about what little was wrong with her and how simple her intervention needed to be!
    GP role undermined again, a sort of game of chicken about acting in patient's best interests. 60+ years of learned helplessness. No hope for NHS at this rate!

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  • But Dr Mahay, the council is clearly embracing modernity and 'alternative medicine'. Every Homoeopath knows that the more you dilute something, the stronger it's effects will be; so further dilution of childrens' mental health services will result in a much stronger effect, and if it costs less to use less to start with, that is even better.
    You should strongly support them, but only in a very dilute way, of course.

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  • Ex-GP

    Cut services elsewhere and people will book to see a GP to obtain the sevice there...even if there isn’t a service for us to provide and no funding for it. It won’t stop them booking in to see us to get help. And a lot of us will, we will prescribe champix/nicotine patches etc and they will book in to see us to get more. Young people and their parents will book in to find out there isn’t a mental health service we can refer to, they’ll still book in and then there’ll be an appointment discussing how there isn’t a service, they should discuss the issue with their school and then some of them will demand a referral to a psychiatrist or a letter for their school. The default source of help is a GP...if there is no service we can offer we’ll either be forced to cobble together some kind of help ourselves or tell them we can’t help. But it won’t stop people booking in because there is nothing we can do to stop anyone booking themselves in for anything they want, anything at all, because it’s free and there’s a perception that we are responsible for just about everything. Problems don’t disappear just because a council or anyone else stops funding a service for it. They just book in to see their GP instead.

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  • Any service that is cut and unavailable should be referred directy to their elected representative, the MP in their surgeries then they can explain why these services have been cut.

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  • Dear Nigel,
    Where has the article on Babylon costing their host CCG £150,000 in 2 months gone?
    Paul C

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  • That was on another, less well known, GP news platform

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