Relationships between general practitioners and psychiatrists What general practitioners expect of psychiatrists

GPs expect psychiatrists to possess and exhibit specialized skills of assessment and management not possessed by the primary health care team and to be available when appropriately needed. Because of sheer numbers (in England and Wales there are 12 times as many GPs as psychiatrists) the GP must protect this valuable resource by not overloading it with inappropriate referrals and by obtaining and maintaining certain assessment and management skills that can be used in primary care as well as sharing the care of certain patients under the leadership of secondary care. GPs expect the psychiatrist to provide inpatient care when needed (e.g. serious self-neglect, suicide intent, etc.) and day-patient facilities to provide a place of care, respite, and safety. They can also expect the psychiatrist to use diagnostic facilities and investigations (e.g. scans) as necessary and to provide highly specialized treatments when indicated (e.g. electroconvulsive therapy). Less frequently, the GP may need respite from particular doctor- patient relationships for the longer-term good (e.g. heartsink patients). Referral is also sometimes a result of pressure by the relatives or patient.

Access to specialist assessment when appropriate is paramount for a primary care service. GPs are not usually trained in specialist assessment and therefore, to match need to services, a psychiatrist, community psychiatric nurse, or psychologist from the community mental health team can perform this function, often in a primary care setting or the patient's home. Other community mental health teams operate an outpatient clinic (which may be moved into the surgery). Often 'true consultancy' is being sought by the GP, whereby he or she may receive advice only. Other practices operate a joint consultation system whereby the specialist and generalist see the patient together and formulate a plan.

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