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On the face of it, the government’s announcement on 13th December 2012, about giving patients a choice of consultant psychiatrist is a great idea, some may say long overdue. However my prediction is that for many Trusts, up and down the country this will cause enormous headaches and they will struggle to comply.
Why? Simply because, for the last 25 years or so, mental health services in England, at least, have been ‘sectorised’. That means that loads of time has been invested in divvying up the GP practices and allocating a certain number of human resource to each area. Modern psychiatric care is based on the Community Mental Health Team and not the psychiatrist; many people don’t see the psychiatrist at all!

I have no reason to think that my old Trust is any better or worse than any other, but it has taken them 4 years, and counting to make the last change, which shrinks the number of consultants in each team – the only blessing is that they have waited so long that several changes have been incorporated along the way and this one might just be included as teams are amalgamated.

However it only needs one unpleasant psychiatrist, whom no-one wants to see, or one particularly popular one for the entire system to be thrown out of kilter as community psychiatric nurses and others struggle to move around the system in pursuit of this patient’s nirvana.

And this is only within the NHS. Presumably the government will extend the ‘any willing provider’ franchise to outpatient psychiatry. Well a lot of private psychiatrists might want to get on board but what will happen when the NHS is left to provide the community nursing care? Will we see NHS nurses seconded to private psychiatrists. I think not – at least not without some very drastic changes in thinking.

In practice I suspect there will be the usual fudge, with GPs rubber stamping letters with the ‘Choice offered’ label whilst patients, unaware of their rights, continue to see the same doctors they always have. Nice idea, David, less easy in practice…

Danny Allen

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