The GP curriculum includes the need to attain competence in managing threatened or attempted suicide, delirium, psychosis, panic, aggressive or violent patients, drug overdose and alcohol withdrawal.
GP trainees should attain a level of proficiency in these skills that enables them to feel confident in assessing when referral to psychiatry is appropriate or not.
However, junior doctors – including GP trainees – are now performing fewer emergency assessments than before, as specialist nurses based in A&E have been shown to reduce waiting times and improve capacity. So are GP trainees seeing enough emergency psychiatry referrals during their on-calls within a psychiatry post?
We examined psychiatric emergency assessments carried out by GP trainees (among other trainees) at the Royal Liverpool University Hospital A&E department over a six-month period from December 2008 to May 2009.
Only 17% of 832 patients were seen by the GP trainee, core trainee or F2 doctor alone, and a further 8% were seen in combination with a mental health liaison nurse.
We went on to successfully amend the rota to ensure that GP trainees are based in the A&E department from August 2010 onwards to see more emergency referrals, which will help trainees gain a fuller appreciation for the acutely mentally unwell patient and become more proficient in referring patients to specialist mental health services.
Dr Nishan Bhandary, specialty registrar, psychiatry, Aintree, and Dr Alister Pinto, CT2 in learning disability, Southport