WIBU to complain that not one of the doctors at my supersurgery has a particular interest in mental health?

[MrsHathaway]

I was browsing my GP surgery's website today to see if I could remember who I last saw because a couple of the GPs I don't find particularly lovely and I'd rather not waste anybody's time.

In the profiles bit it lists their particular interests - eg there's someone who has a particular interest in joint complaints, and people who have a particular interest in male and female sterilisation respectively. Each of the doctors has three or four areas of particular interest.

Not one of the many doctors lists mental health.

It's estimated that one in four GP appointments relates to mental health issues, and 23% of the burden on healthcare in the UK. A fucking QUARTER, and not one GP who is the go-to person in my absolutely enormous practice.

That's just wrong, surely? Even if every single one of them has had intense training on MH issues and are all experts, there's not a whisper of it on their brand new and shiny website, or newsletter, or practice handbook.

I've been through the entire website. There are two references to mental health - one saying they have links to the area CPN, and the Samaritans' number in their links to other agencies.

It gives the impression that mental health isn't really part of their remit, when actually they're the first port of call.

Late night irritation but I'm wondering whether this is an issue that ought to be raised through formal channels (in the first instance, with an email to the practice manager)? Am I just being precious?

As a nutter I'm far more concerned about the lack of GPs with a mn speciality than the Ops obviously tongue in cheek use of the word nutter.

Yes, apologies to those who didn't realise I was rolling my eyes and thinking about a board meeting in which someone pursed his/her lips and used it disparagingly, as though anyone with less than perfect mental health is going to be completely inhuman.

Good reminder to be more accurate in one's terminology, however.

There is a tendency in large organisations to want to pick and choose one's clients/workload/specialisms. "We don't really do X" is a very healthy position for a private company to take, so it doesn't spread itself too thinly or offer substandard goods/services.

However, in this case the service provider is (1) an organisation funded by public money (2) and the area in question is absolutely within its remit - see comments above about being the primary contact/triage for all health problems including mental health.

It's supposed to be a focus although £5m special funding within an NHS budget of £115Bn is like giving a toddler its own shiny 2p piece but it's stll the poor cousin.

By the way, I am very very good at writing letters. My letter has been the letter on several MN threads, for a start (not necessarily under this name though come to think of it) and the last letter I wrote to the practice resulted in their changing their appointment booking system. If I do write, it will be from a perspective of "As a patient I don't find it immediately obvious who I should see for a mental health problem - I know I can see anybody at all but how would I know who's the particular expert?" rather than "Your website sucks".

Great post, BaconYum, and again apologies for any offence inadvertently given.

I would politely point out that the website gives the impression they're not particularly interested as a practice in supporting patients experiencing mh problems.

Yes, that's just it. I'm sure they think they are, but in crisis would a patient think they were? The fact that they give details of the services available to patients with (eg) diabetes or asthma but not depression, when the numbers must be similar (and significantly comorbid), gives the impression that it isn't a priority.

I'd be happy to see any of my colleagues about a primary care MH problem - presentations are so common that you really don't need to have a special interest tbh. And all trainees get loads of training too, the exams are v robust. Anything beyond that should be going to secondary care really (atypical diagnoses, psychosis, treatment resistant depression, personality disorders etc).

I suspect the fact that psychiatric problems are so common is the reason no one GP has it as a specialty as all the GPs need to be able to do it. You only need 1 GP to do vasectomies though (if that) so if a GP does that it's unusual so more likely to be listed. Similarly all the GPs don't usually do child health surveillance although all GPs should be able to deal with childhood illnesses. Diabetes is increasingly complex so often 1 GP is in charge of that.
I would only expect them to list interests when they want to funnel people with a particular problem towards one doctor. I also doubt any one GP wants to see nothing but psychiatric problems. It's time consuming and emotionally draining.

Isn't that also true of diabetes, family planning, sports injuries, etc?

Shit, I've just found "psychiatry" for one of them - glad I hadn't emailed. I'm not sure that that's quite the same as mental health though TBH. Will have to have a think.

That is, you can need a psychiatrist without currently having a mental illness and vice versa, surely?

And having one GP who is currently on long leave interested in psychiatry doesn't address the absence of any other mention of MH elsewhere.

That's the thing 2rebecca. I see far more new diagnoses of depression or anxiety, than I do patients with coughs and colds (a) because the message is getting out that most coughs and colds don't need a GP appt, and (b) our nurse practitioner mops up the rest.

So the severity and complexity of what GPs do see has increased significantly over the past decade. Every single surgery session will have at least a handful of patients with significant mental health issues, so it's very much an every day thing to a GP, and we all should have high level skills in primary care management.

We have a GPwSI in dermatology at our practice and we use her for in house referrals. So we do the standard stuff, and refer her patients where initial mgmt of straightforward skin conditions hasn't been fruitful, or it's a tricky diagnosis. But 90% of the skin stuff doesn't go to her.

psychiatry is mental health/illness though.

Why would you need to see a psychiatrist if you were mentally well?

Frances I am very glad to hear that the message is getting through about self-care and alternative routes (hopefully the pharmacists are getting more business and not just your nurse practitioners).

Do you think there ought to be MH specialists in GP surgeries? I take the point that it can be very wearing work but there are plenty of specialists in hospitals etc so these remarkable humans do exist. If MH is such a large proportion of your work, surely it would be efficient to have a specialist deal with them in the first instance - certainly beyond the second appointment perhaps.

You might continue to see a psychiatrist while you are not suffering if you have a chronic MH condition; like I see my endo sometimes even when I'm euthyroid.

"Mental health" is Orwellian new speak. Doctors will deal with mental ill health or psychiatry.

I've definitely misunderstood, then. I may be getting muddled with the scope of a psychologist.

Clinically, "psychiatric" is synonymous with "mental"?

Etymologically I know it is, but is it in practice?

It would be fantastic to have an in house specialist, yes, but that goes for pretty much any area of medicine. The answer re psych is funding and resources. We have inadequate numbers of psychiatrist in our area, so chances of getting someone in house is a pipe dream. There is no recognised PG Cert in Psychiatry for Primary Care that I've ever come across. Psychiatry training is so depleted at the moment; they're running on empty. In the north the fill rate for psychiatry training scheme is about 30%. Even in popular areas it's only 70% or so.

If we sent every patient with depression to a psychiatry specialist after their second appt community psych services would implode within the month. There's absolutely no reason a GP with standard GP training can't manage 80-90%+ mental health / psychiatry problems themselves - and they do. (with appropriate referrals on to counselling services/ charitable sector too obv) - vast majority need not go anywhere near a community mental health team.

Bugger.

And that's even once you've recruited enough GPs anyway

If the total NHS budget is £115Bn and we estimate that MH/psych is around a quarter of the work and hopelessly underfunded, how would you spend £40Bn per annum on additional MH provision? ::buys lottery ticket::

only a very few patients with chronic severe mental illness (like schizophrenia) will remain under their psychiatrist when well. And even then they wouldn't need to see a Dr; they would have a care coordinator to look after them until/if/when they relapse and need medical input again. That's on the NHS

If you have private cover you can see your consultant whenever you like of course

(with appropriate referrals on to counselling services/ charitable sector too obv)

Yes, the problem being the eighteen-month waiting list. Funding again.

Although we're getting slightly off the point.

MH/psych horribly underfunded. Work very demanding and even where specialist training is offered it tends not to be taken up. There won't be a MH specialist in even a big practice.

All that's a given, now.

To what extent then should a patient expect MH to be mentioned in the information/publicity she receives or seeks out from her practice?

We'll my practice is not perfect, but we have a page on our website with info re depression/ anxiety - self help guides, a dozen or so phone numbers, links to local nhs counselling service, downloadable PHQ9 and GAD7 questionnaires etc.

Plus various posters in waiting room etc.

Then if you do have a problem you should expect good care from whichever GP you see including more specific signposting to relevant agencies, and the correct threshold for involvement of secondary care for the minority who aren't doing well in primary care alone.

That sounds great, though, honestly.

Having a section about mental health shows that you acknowledge it as a normal part of your job. Having questionnaires (is that the Glasgow one you get at ante- and post-natal checks?) is a non-judgemental way of quantifying (IYSWIM) whether a person has reached a point where help would be useful, like a cough for three weeks rather than saying "persistent cough".

I think it depends on the practice. My surgery's leaflet doesn't contain more than details of who works in the surgery, how it works, how to get repeat prescriptions, what to do in an emergency. It's not a list of links to other agencies but just about the surgery.
Doctors I know say they have to fund the leaflet themselves so extra pages giving links to other agencies aren't going to be a priority. It's not meant to cover all illnesses, just how the surgery works.
I think you're expecting too much from your surgery leaflet.

My surgery's webpage is just a page on the healthboard website. The links page is empty but there are links on the general health board website but mainly to hospitals, social services etc. The surgery specific stuff is very limited and contains less than the leaflet, although I didn't know they had a website until I just looked.
The GPs just have their names and qualifications listed.

I think you're expecting too much from your surgery leaflet.

Quite possibly, although if I linked it you might see why. I think it's the disparity between how much they talk about their linked osteopath and semi-private cosmetic procedures, and how much they don't talk about MH which we know is an absolute core area.

I appreciate that that's how advertising works but I still don't like it.

It's a brand new expensive website redesign so it's not as though they didn't have an opportunity to provide some relevant content.

Thing is those questionnaires don't always give the conclusion that a person does need help.
I don't think it would be useful having a gp specialising in mh.
All gps know mh. It is common place now.
Some patients may get the idea that they should wait for an appointment with this specific person.
With everyone with mh problems booking in, imagine the wait?
I can wait 3 weeks or more just to see my primary doctor.

frances i think it's terrible the time slots you are given! I think my practise may have been cut down to 5minutes! ( or it was that day) how can you actually sort anything out in that time?
Especially mh problems!
Some people come in about somethingelse before they will talk about their mh.
It's awful if you have several things wrong with yourself!
I'm very lucky that my doctor takes the time for me.
I think doctors are very under appreciated!