Psychiatric Bulletin (2007) 31: 315. doi: 10.1192/pb.31.8.315a
© 2007 The Royal College of Psychiatrists
New Ways of Working threatens the future of the psychiatric profession
Martin Gee, Consultant Psychiatrist
Moorlands North Adult Community Mental Health and Social Care Team,
Cheddleton, Staffordshire ST13 7ED, email:
ChristineM.Sales{at}northstaffs.nhs.uk
I sometimes wonder if I am the only psychiatrist who has misgivings about
the direction our professional body is heading under New Ways of Working for
Consultant Psychiatrists. Its impetus came from recruitment and retention
problems in the profession some time ago, but the climate has now changed and
many candidates are clambering for posts that trusts would have previously
struggled to fill. In some areas there is a real threat of redundancies among
doctors.
Out-patient clinics have largely been condemned by the new system as being
purposeless and inefficient. I am not sure that service users would agree and
the perspective of primary care has yet to be obtained. Most people who have
an illness want a humane assessment by somebody who understands their problem,
has seen it before and knows how to treat it. The professional status to
deliver this only comes with experience and training. Assessment, diagnosis
and treatment of people newly referred to psychiatric services can therefore
not be so easily delegated to other professional groups who are not trained in
diagnostic theory or nationally assessed for their ability to perform this
important task.
If we, as a consultant body, see a small number of cases, while supervising
others who are seeing vastly more people than ourselves, it is only a matter
of time before we lose respect, credibility and competence. We are the most
highly paid professional group within the mental health services and questions
will be asked about whether we offer value for money.
A major service that consultant psychiatrists have offered in the past has
been continuity of care. Patients have been seen at a point where their
illness begins, through a period of turbulent inpatient care, back out into
the community, through remission, relapse and, hopefully, recovery. The fact
that there is somebody who knows their history, and has seen them through
thick and thin, is I suspect of vital importance to most service users. With
the functionalisation of services and division of in-patient and out-patient
services, we are destroying this continuity, leading to a situation where bits
of care are being individually managed in a limited way with nobody
overviewing the case as a whole. It is my view that quality of care is
suffering as a direct result of this.
There is no other professional group currently that has the academic
background status in society, or the infrastructure for continuing
professional development to take forward evidence-based psychiatry and to
improve the quality of care for people with mental health problems. Nobody
wishes to see burnt-out or ill psychiatrists, but psychiatrists of the future
have to maintain substantive, direct contact with the patients for
professional survival and, indeed, to have anything significant to offer the
health service.
