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Two thirds of GPs providing specialist mental health support beyond their competence


By Rachel Carter
9 May 2022

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NHS pressures mean two thirds of GPs are having to provide specialist mental health support beyond their competence, a Pulse survey has found.

Of over 500 GPs surveyed, 70% said they were providing mental health support outside of their competence to children, and 63% said the same for adults.

The survey asked GPs about the impact of the Covid-19 pandemic on mental health services. Among the types of support GPs said they were having to provide were:

  • Dealing with suicidal ideation in adults (86%).
  • Dealing with mental health crises in adult patients (81%).
  • Monitoring patients who should be monitored by a specialist team (70%).
  • Diagnosing children and adolescents with mental health issues (69%).
  • Dealing with suicidal ideation in children (66%).

Dr Paul Evans, Gateshead and South Tyneside LMC chair, told Pulse his practice is currently managing six or seven patients with eating disorders while they wait for specialist input.

He said: ‘We are an area that has an incredibly limited eating disorder anyway and while we have not seen any change in that service… in the pandemic, we have seen people with eating disorders deteriorate in terms of their symptoms and eating behaviours.’

According to Dr Evans, there have been ‘absolutely loads’ of situations over the last two years where secondary mental health services have tried to pass work over to GPs.

This includes requests to take on the prescribing of antipsychotics before a patient has been stabilised, to initiate patients on ADHD medication, perform weekly ECGs and bloods for eating disorders, and prescribe for and monitor patients with gender dysphoria, he said.

The survey also found that one in 10 respondents said they have to initiate antidepressants for children and young people at least once a month due to a lack of options.

A GP in Wiltshire, who wished to remain anonymous, said: ‘There have been reports of local GPs being asked by CAMHS to initiate medication in under-18-year-olds.

‘I have always rejected these as outside of my competence [but] he problem is that patients are often caught in the middle.’  

The survey highlighted the rise in mental health issues seen during the pandemic, with GPs reporting that around 38% of consultations now have a mental health element, compared to 25% pre-Covid.

At the same time, access to services has become more difficult:

  • more than half (56%) of respondents said their local trust had unofficially raised the thresholds for adult mental health referrals during the pandemic; and
  • 14% said this had been done officially.

The numbers were similar for CAMHS:

  • 17% of GPs said their local trust had employed official policy to increase the thresholds; while
  • 49% said this had been done unofficially.   

One GP based in South East London said: ‘I have not had a CAMHS referral accepted for at least the past two years – all rejected as “not actively suicidal, discharged to GP”.’

Another respondent commented: ‘CAMHS reject every single referral, even in children presenting to hospital with overdose.’

Dr Dave Triska, a GP in Surrey, told Pulse he is managing crisis situations in primary care ‘all the time’ and is struggling to get patients seen by secondary care services.

Earlier this year, he was unable to get a patient with florid psychosis seen by one of the emergency teams, he said.

‘The end of the journey for them was being sectioned for something that was preventable, but the service wasn’t there.’

Pulse’s survey also revealed that the waiting times for some specialist services – such as ADHD and autism assessments for adults and children – are exceeding 18 months.

NHS England is currently working on a draft plan for mental health waiting-time standards, which include a 24-hour target for urgent mental health care. However, it will be subject to Government approval.

Health professionals have also been invited to give evidence to inform the Government’s new 10-year plan for mental health, which aims to reduce the number of people who go on to develop mental health problems.

Read the full findings from Pulse’s mental health survey in this month’s cover feature.

The special Pulse survey was launched in April 2022, collating responses using the SurveyMonkey tool, and was answered by 569 GPs. It was advertised to our readers via our website and email newsletter, with a prize draw for £100 John Lewis vouchers as an incentive to complete the survey. We used midpoint analyses to work out averages for waiting times and proportion of consultations with mental health problems.

This story first appeared on our sister title, Pulse.

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