The Roles and Responsibilities of a Consultant in Adult Psychiatry

In the past two decades there have been great changes in the roles expected of adult psychiatrists, often associated with a perceived reduction in resources. Coupled with the culture of blame and criticism, this has almost certainly contributed to the high rates of early retirement, relatively poor recruitment and consequent high vacancy rates at consultant level in this speciality.

Adult psychiatrists have complained of lack of clarity regarding their roles and responsibilities in the new NHS. In response to this, the Faculty of General and Community Psychiatry has compiled this document. An updated version will appear in 2004. It consists of an introductory paper with five appendices.

The body of the paper gives an overview of the clinical and non-clinical roles of the consultant in adult psychiatry. It sets out those features of training and expertise that distinguish the adult psychiatrist from non-medical members of the multi-disciplinary team and from medical colleagues in other psychiatric specialities. It proposes a change in the name of the faculty to the Faculty of Adult Psychiatry.

There is a brief description of training requirements, necessary skills and resource allocation. The problem of recruitment and retention, particularly at consultant level, is recognised, as are the boundary issues with other psychiatric specialities.

Appendix one is a summary of the College's report on community care.

Appendix two contains the revised model job description for a consultant in adult psychiatry. This is the College's statement about the appropriate job size for one consultant and the resources that should be available. The recommended provision is index-linked to local deprivation. Assumptions are spelt out about the provision of services in other specialities (rehabilitation, liaison and substance misuse) and age group sub-specialities (eating disorders, postnatal, intensive care, dual diagnosis, early onset psychosis, assertive outreach, court diversion, crisis resolution/home treatment and neuropsychiatry). It is made clear that where these are not provided there is a corresponding need for increased numbers of sector consultants.

Appendix three deals with the interface between adult psychiatry and the other psychiatric specialities. It sets out the issues relating to the service interfaces with the other age groups (child and adolescent, old age) and specialist need groups (forensic, learning disabilities, substance misuse and psychotherapy).

Appendix four sets out the further work to be undertaken within the faculty and in its relationships with branches of medicine inside and outside the College.

Finally, appendix five deals briefly with adult academic psychiatry.