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A survey of more than 1,000 GPs has revealed rising demand for mental health support in primary care. GPs say that two in five (40 per cent) of their appointments now involve mental health, while two in three GPs (66 per cent) say the proportion of patients needing help with their mental health has increased in the last 12 months.
Mind, which carried out the survey, is calling for better mental health training for GPs. Current initial training for GPs can be limited; only one of the 21 compulsory modules for trainees is specifically dedicated to mental health. Trainees have the option to undertake a placement in mental health but most will have completed this in a hospital, rather than in community-based mental health services. In the survey, four out of five GPs agreed there should be a wider range of options for mental health training.
Mind is backing existing calls to extend GP training from three to four years, to allow more time for trainee GPs to gain experience in mental health, and calling for a wider range of relevant mental health placement options.
The charity is also calling for progress in England on plans to introduce more mental health therapists linked to GP surgeries, to alleviate some the critical shortfall in the primary care workforce. Plans to introduce 3,000 therapists by 2020 have been outlined in two separate NHS England plans – the GP Forward View and the Five Year Forward View for Mental Health – but progress has been slow.
Paul Farmer, Chief Executive of Mind, said:
“For most of us, our GP is our first port of call for accessing support for our mental health on the NHS, and the majority of people will only ever be seen in their GP practice. As demand increases, it is more important than ever that the NHS gets that support right.
“GPs do a really difficult job. We know it can make a huge difference when our GP is knowledgeable and confident about mental health, or when we find that a physical illness is affecting our mental health. When they are well supported and receive specialised, relevant and ongoing training, they are better equipped to provide the best care.”
Dr Richard Vautrey, British Medical Association GP committee chair, said:
"GPs want to offer the best possible care to their patients and are working hard to do so, despite the challenges created by a decade of underfunding. At the same time, the number of patients needing help with mental health problems is increasing.
“We not only need greater investment in community-based training to give GPs more opportunity to develop their skills but also a significant increase in mental health therapists directly linked to practices. This would reduce the unacceptable delays many patients currently face getting access to the care they need."
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said:
“GPs everywhere are noticing a big difference in the number of patients seeking help for their mental health problems. This may be because people are becoming more open about raising concerns about their mental health issues but, whatever the reason, we need to ensure that our GPs are as prepared as they possibly can be to deliver care to their patients.
“We are very encouraged by Mind's support for our bid to extend GP training. Today's GPs are expert generalists and exceedingly competent, but the GP caseload has increased exponentially in both quantity and complexity in recent years. Patients with mental health issues deserve parity of esteem with those with physical health issues, and it is important that our GPs of the future are supported with a training programme that reflects the diversity and complexity of modern day general practice.”
Dr Timothy Cooper is 30 and lives in Basingstoke, Hants. He is a GP trainee, and completes his training in July 2018. He says:
"As part of my rotations I was very lucky to spend six months in an in-patient psychiatric hospital as well as an out-patient clinic. This was hugely useful in helping my understanding of mental health. Mental health is not discriminatory - it affects people from all walks of life and as a GP you're bound to come into contact with many people affected by these issues.
“When training as a GP, it's important to see people at both ends of the spectrum - those acutely mentally unwell in places such as A&E but also people with less severe mental health problems, the types of problems you're more likely to encounter day-to-day in the surgery.
“Offering trainee GPs more types of mental health placements would be invaluable. If you want to become a consultant that's seven or eight years' training whereas for GPs it's just three years. An additional year's training would also allow trainee GPs more time for rotating through specialties such as mental health and broadening their own interests."
Dr Barbara Compitus lives in South Wales, and works in Bristol and Pontypool. She has been a GP for 16 years and has an interest and additional expertise in mental health. She says:
“I’ve noticed an increase in patients using terms like 'depression' and 'anxiety' - people are much more open now. When I first started out as a GP it was tough to get these kind of things out of people who’d often have made an appointment for a physical health problem, even though they might have been struggling with mental health too.
“As a locum GP, I cover for GPs when they're off sick, meaning I get to choose where I work, when I work and what I do, which helps me manage my own wellbeing. Offering more mental health training to trainee GPs, would allow them to feel more confident when dealing with the high volume of patients experiencing these types of problems. Ensuring they have the tools to recognise their own mental health needs as well as those of their patients is essential.”
Mind has written a letter to Health Education England, co-signed by the British Medical Association, the Royal College of GPs, Rethink Mental Illness, Mental Health Foundation, Centre for Mental Health, the Mental Health Network and the Royal College of Psychiatrists. Read the letter.
This work is part of Mind’s 'You and Your GP' campaign to improve primary care support for people with mental health problems and support GPs to looking after their own mental health. Our Find the Words guide aims to help people talking to their GP about mental health make the most of their 10 minute appointment.