‘A complete disaster’: Psychiatry resignations felt by GPs

As concerns continue to mount over the impending resignations of hundreds of NSW Health psychiatrists over a pay dispute, GPs are already feeling the impact.
 
Among them is Dr Ken McCroary, a GP in southwest Sydney, where a significant portion of his patient base require mental health care and are at a socioeconomic disadvantage.
 
He told newsGP news of the walk-out alone has caused notable unease among his patients about whether they will have access to care and medication.
 
‘My major issue has just been the amount of anxiety the patients are coming with,’ Dr McCroary said.
 
‘They’re worried about further delays for their therapy. They worry about further delays in management.
 
‘This morning there was a lady who’s like, “Oh my god, I’ve been stressing about when my daughter turns 18 anyway, having to find adult treatment. Is this going to mean we’re not going to do that? Who’s going to prescribe her ADHD meds when she turns 18?”.
 
‘I don’t quite have an answer to that one.’
 
But what he does know, is that any resignations are likely to add unprecedented pressure on GPs, who already have a significant mental health caseload, and are time poor.
 
‘I personally don’t have any more space in my day, and I talk to my colleagues, particularly those that have interests with mental health, and it’s not like you suddenly have gaps opening and extra time you can squeeze stuff into. It won’t happen,’ Dr McCroary said.
 
‘So, there’s going to be a continuation and a worsening of this health deficit, of people not getting the therapy that they need and deserve, in a first world country.’
 
RACGP NSW&ACT Chair, Dr Rebekah Hoffman, is not surprised to hear Dr McCroary’s experience. while there are still many unknowns of what is to come, she says there will be an enormous impact, both for patients and GPs.
 
‘I’m really worried about GPs and potentially burnout, when they’re going to have to be managing an additional mental health load,’ she told newsGP.
 
‘We already know that 71% of GPs’ consults are mental health based, and our biggest fears at the moment are when we’re presented with an acute, deteriorating patient who needs an inpatient bed that we won’t be able to find one.’
 
NSW Health confirmed on Thursday that 43 psychiatrists had engaged in the mass resignation, with the number expected to rise in the following days. To help ease any resulting pressures on the system, 31 locums had been engaged.
 
The State Government also confirmed talks are underway to redesign the system to increase the scope of practice of others working in the mental health space, including GPs.
 
While the focus is currently on NSW, Mental Health Minister Rose Jackson said conversations are happening Australia-wide.
 
‘We have other health professionals stepping up, putting their hand up to play a role,’ she said.
 
‘There is an opportunity to look at how we can deliver better, holistic mental health care, wrapping services around people, those psychological supports, whether it’s through social workers, whether it’s through peer workers, whether it’s through clinical psychologists, whether it’s through general practitioners, and that is something that the Government is exploring as well.
 
‘So that is a conversation that has commenced and is national.’
 
For Dr McCroary this is a ‘no brainer’, particularly when it comes to expanding GPs’ scope to initiate and prescribe medications.
 
He says GPs are already managing patients with mental health conditions in the period between seeing their prescribing doctor, including any side effects and day-to-day issues.
 
‘I hope it’s a wake-up call,’ Dr McCroary said.
 
‘We have a lot of experience with the condition [and] the medication. It’s an arcane sort of thing that … we’re not initiating medications and therapies for this significant issue.’
 
He says the effects of not having access to medications for these conditions are far reaching, impacting not only the individual’s ability to function and attend their place of study or work, but for families, the dynamic as a whole.
 
‘In families, parents are arranging their life around getting their scripts from their psychiatrists, and they’re really worried they won’t have access to that now – that’s been the biggest impact for our practice,’ he said.
 
‘I know there are other significant issues with the ability to get treatment for inpatients in public hospitals, that’s going to be a complete disaster.’
 
The RACGP has long been calling for a nationally consistent approach for ADHD prescribing, and recently renewed its push in response to the resignations, strongly advocating for the NSW Government to prioritise reform to expand GPs’ scope of practice to be able to initiate and prescribe medications for the disorder.
 
In NSW, GPs can be approved to become other designated prescribers, however Dr Hoffman says it is a lengthy process.
 
‘What we’re really asking for is all of the GPs, you have the knowledge and skills and training already to be able to do this, to get their applications fast tracked,’ she said.
 
‘So that they can actually go ahead and start prescribing these medications when they’ve already got the skills and ability to do so.’
 
Dr McCroary agrees.
 
‘Another year’s just kicked over, and I’m still having to write referrals for people with no money to go and pay lots of money to get their script from their specialist do something that I’m quite comfortable and quite competent, quite able to be doing myself,’ he said.
 
‘It would be nice to have this issue resolved and benefit our patients in the community.
 
‘It should not have got to this stage.’
 
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