Wake-up call for British psychiatry: responses

I thoroughly enjoyed the Editorial by Craddock et al, ¹ and would like to address the following points. First, the perceived ‘lack of recruitment and retention in psychiatry’. Though there has been considerable mention of this, anyone involved in psychiatric training or workforce planning recently will be aware of the changes in numbers in the years since systems such as New Ways of Working ² were conceptualised. What has not been mentioned (and what is more pertinent) is the effect of such changes on future recruitment and retention.

Second, the educational standards that we, as trainees, are expected to achieve are laudable, and (justifiably) a great deal of effort has been spent over the years by the Royal College of Psychiatrists to refine these (a recent example being the curriculum submitted by the College to the Postgraduate Medical Education Training Board). The delegation of assessment to multidisciplinary team members, without adequate, standardised assessment of competency, is worrying. Clinical experience has shown that GPs, when they refer patients, might not have conducted an exhaustive neurological examination or battery of tests to exclude organic causes, and would expect these to be picked up by secondary services. It is beyond the boundaries of reason (and team supervision) to expect multidisciplinary team members to be aware of organic presentations, neuroendocrine signs and symptoms, and subtleties on history and mental state examination that come with the experience (and training) of a psychiatrist. The equivalent would be a neurology service expecting a physiotherapist to assess patients referred with unexplained weakness and muscle atrophy; certainly the physiotherapist may have an important, specialised role in treatment, but the initial assessment should be by a physician, who will have a broad knowledge base, refined by training and experience.

Our patients present in complex ways and to reduce their assessment to rating scales, symptom checklists and risk management (as is currently the vogue) makes a mockery of the skills needed to practice psychiatry to an adequate standard. By delegating initial assessment to generic team members, the art of psychiatry appears to have been reduced to a ‘paint by numbers’ approach, that is anything but patient-centred. Looking at the fashion in which changes have been implemented, it is easy to make comparison with other Department of Health initiatives (such as the Medical Training Application Service/Modernising Medical Careers fiasco ³ ). On this occasion, however, the College has the opportunity to effect change. The gauntlet has been thrown to the College to poll its membership on the implementation of New Ways of Working; this issue will not go away and needs to be resolved.