HL Deb 20 October 1999 vol 605 cc1092-6

2.53 p.m.

Lord Lamingasked Her Majesty's Government:

Whether they have any plans to improve the training of general practitioners in response to the growing number of patients with mental health problems who consult them.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, appropriate training is currently available for all general practitioners to help them meet the mental health needs of their patients. In addition, we are introducing a modernised system of GP training early next year which will ensure that all trainee general practitioners receive an educational needs assessment at the beginning of their general practice training. That will ensure that a range of appropriate experiences will be on offer.

Lord Laming

My Lords, I am grateful to the Minister for that helpful reply. Perhaps I may take this opportunity to congratulate my noble friend most warmly on his appointment as Minister. I feel sure that all Members of your Lordships' House will feel that this promotion is well-deserved, and we wish him well.

Does the Minister agree that the vast majority of people who experience mental health problems are now cared for by the primary care teams? Is he aware of the recently published survey initiated by the Mental After Care Association which indicates that GPs spend as much as 30 per cent of their time on mental health problems, and yet many of them feel ill-equipped to deal with that work, especially when it is complicated by a greater misuse of drugs?

Lord Hunt of Kings Heath

My Lords, I thank the noble Lord for his warm welcome. Of course, he is right. Most mental health problems are dealt with by primary care: by GPs, by other support staff and by community psychiatric nurses. I believe that the survey which he mentioned is important and it is one that we are considering very carefully. However, I am satisfied that the appropriate arrangements are in place to ensure the training of GPs to undertake this role, both at undergraduate level in training to be a GP and in the crucially important area of continuing professional development once they have become GPs.

Lord Clement-Jones

My Lords, I join the noble Lord, Lord Laming, in congratulating the Minister on his appointment. The noble Lord, Lord Laming, mentioned the survey of the Mental After Care Association which did, indeed, raise some worrying issues about the training of GPs. In the light of that survey, have the Minister and his department made an assessment of the implications of Professor Graham Thorneycroft's national service framework proposal? In particular, have they considered what further resources in terms of training and recruitment will be required? Will the £700 million over three years promised by the Government be adequate? In addition, will sufficient community psychiatric nurses be available in the light of the current major shortages? Do the Government have accurate figures in that respect?

Lord Hunt of Kings Heath

My Lords, again I thank the noble Lord. We are not aware of any particular problems in relation to community psychiatric nurses. However, a survey is being undertaken at the moment and we hope to have the interim results by March 2000. I believe that it is worth making the point that community psychiatric nurses play a very important leadership role. It is an attractive role which is very helpful in relation to future recruitment. I am glad that the noble Lord mentioned the £700 million extra resources which we are putting into the health service over the next three years for mental health services. That will undoubtedly help to underpin the development of a national service framework, which in itself will underpin the integration of both primary and specialist services.

Lord Rea

My Lords, as a former general practitioner, I congratulate the noble Lord, Lord Laming, on the relevance of his Question. It is not only a question of knowledge per se but of attitude. Like many of us, some doctors find emotional problems difficult to handle as well as extremely time-consuming. Therefore, is not a team approach, as was mentioned earlier, the most suitable way to handle such problems? A general practitioner should be able accurately to spot a problem and then refer the patient to another member of the team, such as might be done, for example, in a primary care group. Is my noble friend aware of the very good work that is being done by the Royal College of General Practitioners' primary care mental health education unit and also in conjunction with the Royal College of Psychiatrists?

Lord Hunt of Kings Heath

My Lords, first, I agree with my noble friend that the Royal College of General Practitioners has done sterling work over 40 years in helping to drive up the quality of primary care services and particularly the work of general practitioners. Of course, some people who have mental health problems present major challenges to GPs. It is important that we have the right structure to enable the service to deal with those effectively. That is what the national service framework is about. It recognises the pivotal role of primary care and that GPs and support workers, whom my noble friend mentioned, have a major role to play. But it also develops protocols for the effective referral of people with severe mental health problems to specialist services, and it enables specialist services to provide support and advice to general practitioners in their general work.

Baroness Masham of Ilton

My Lords, is the Minister aware that in some health districts mental health teams go from hospitals into GP practices or other health services in order to work together with the GPs? That supports the GPs and they learn on the job. Is the Minister aware that that happens in the Yorkshire Dales?

Lord Hunt of Kings Heath

My Lords, if I was not aware, I certainly am now. I am very glad to hear it. One can develop effective services in a whole range of ways. The working together of different sectors of the health service and the seconding of mental health service to primary care are important examples. Primary care groups enable GPs collectively to commission the provision of such services. They will be able to set the quality and agree on the kind of staff that they want to help them. As a result of using that method I am sure that we shall see a much more effective and integrated service in the future.

Lord McNair

My Lords, does the Minister realise that people who are treated for mental illness are not first screened to see whether their symptoms are the result of a physical condition or imbalance, particularly a nutritional imbalance? Does he believe that that screening is essential? Why does it not happen? Surely, that is more important than training doctors as psychiatrists. We need to train doctors to be better doctors.

Lord Hunt of Kings Heath

My Lords, the noble Lord always puts an interesting point of view. I have no doubt that when a GP carries out an initial assessment of a patient it is important that he has the right tools to be able to do so effectively. It is well known that patients sometimes present themselves to GPs with physical ailments when in fact ailments of the mind are the problem. The effort being undertaken, particularly into continued professional development for GPs, will enable us to address many such issues and ensure that GPs are kept up to date with developments, whether they are newly qualified or have been in practice for 30 years.

Baroness David

My Lords, can the Minister tell us whether GPs have enough counsellors to help them deal with patients with mental health problems?

Lord Hunt of Kings Heath

My Lords, my noble friend is certainly right to point to the value of counsellors, as other noble Lords have pointed to the value of community psychiatric nurses. There is no doubt that professional counsellors who have been well trained can provide an effective service within the GP setting. I believe that the work we are undertaking in developing a national service framework will enable us to quantify better whether there are enough counsellors. I also believe that primary care groups will be in a better position to commission those services and to enable there to be a balance of people available throughout the GP practices within the primary care group.

Lord Rowallan

My Lords, is the Minister aware that several charities have extremely extensive lists that could be useful to GPs. I refer particularly to SANE Line—I declare an interest as a director of SANE—which has a list that could be used by GPs for every circumstance that we are talking about today.

Lord Hunt of Kings Heath

My Lords, I pay tribute to the work of SANE and indeed to the noble Lord and his interest in this subject. When talking about support staff and the availability of support to primary care it is important to remember that the voluntary sector has a crucial role to play.

Lord Colwyn

My Lords, is the Minister aware that much mental illness is successfully treated by natural and complementary methods of medicine? Will the Minister confirm that it is essential that there should be adequate training for doctors in such forms of medicine in the undergraduate curriculum?

Lord Hunt of Kings Heath

My Lords, the evidence is that medical practitioners increasingly are prepared to look at the opportunities that effective complementary medicine has to offer.