New Ways of Working threatens the future of the psychiatric profession

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.