Mind Cymru calls for better training and resource as GPs say numbers have increased in last year
A survey of 100 GPs in Wales has revealed rising demand for mental health support in primary care. GPs estimate that two in five (40 per cent) of their appointments now involve mental health, while more than half of GPs (58 per cent) feel the proportion of patients needing help with their mental health has increased in the last 12 months.
Mind Cymru, which carried out the survey, is calling for better mental health training for GPs. Current initial mental health 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 Cymru, along with the British Medical Association and the Royal College of GPs, 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 settings, and calling for a wider range of mental health placement options.
Sara Moseley, Director of Mind Cymru, 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 vast majority of people will only ever be seen by their GP. 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 Dave Wilson is 36 and lives in Pembrokeshire, West Wales. He has been a fully qualified GP for six years. Dave said:
“I work in quite a deprived and rural area and I’m seeing more and more patients with both mental health and social issues. I do lots of home visits and see lots of isolation and loneliness. I know my patients well, but I don’t know whether that means people are more or less likely to be open about their mental health. I estimate that mental health accounts for up to 50 per cent of my caseload. Although it’s an immensely rewarding and enjoyable job, being a GP can be tough and there is becoming increasing recognition of mental health difficulties within the profession itself.
“Offering trainee GPs more training in community mental health settings, extending training from three to four years and enhancing the provision of GP support services would help us better identify and treat problems among patients, colleagues and ourselves.”
Dr Chris Bryant, a GP since 2015 and based in Cardiff, added:
“I’ve definitely noticed an increase in mental health-related consultations, particularly those involving patients experiencing the stresses of the changing benefits system. Cardiff is a very mixed area with some patients from affluent backgrounds, and others deprived. There's a correlation between lower socioeconomic status and poor mental health but I come into contact with people with mental health problems from all backgrounds.
“I see many people experiencing stress, anxiety and depression, and try to be as empathetic as possible while also not to taking too much home with me. Confidently signposting someone who is mentally unwell within a 10 minute appointment is a challenge, as are long waiting lists for mental health services. I didn't undertake any training in mental health and believe it would be a good idea to offer trainee GPs more training in other mental health settings, but we also need to look at the onward referral process and make sure that there are enough services available to support people with mental health problems.”
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.”