Wake-up call for British psychiatry: responses

Craddock et al's ‘Wake up call for British Psychiatry’ ¹ is a timely reminder of the need for our profession to reassert its essential qualities, particularly in view of the current low recruitment rate into psychiatry from UK graduates. The Psychiatric Trainees' Committee (PTC) agrees with the observation that the medical component of psychiatry is being devalued. Indeed, this is apparent in many of the recent changes associated with psychiatric training.

The European Working Time Directive has in part contributed to reduced exposure to emergency psychiatry. This has resulted in a reduction in the recognition and management of biomedical aspects which are often key in acute psychiatric presentations. This has been exacerbated by financially stretched trusts gradually reducing the out-of-hours contribution from trainee psychiatrists in favour of cheaper alternatives.

New Ways of Working remains contentious. Specific consideration is required to ensure that postgraduate training adapts both in substance and in delivery to ensure that future psychiatrists have the necessary skills to fulfil the changing role of a consultant. Trainees are increasingly anxious that the rapid evolution of New Ways of Working has become a driver for preventing essential continued expansion in the numbers of consultant psychiatrists. Indeed, there is a growing political atmosphere suggesting that consultants will be needed less abundantly than at present. ² The PTC firmly believes that the introduction of a sub-consultant grade will diminish the endpoint of training, further devalue the profession and not serve the needs of patients.

These issues, alongside the changes resulting from Modernising Medical Careers and the significant stresses of the Medical Training Application Service, are contributing to a cohort of trainees who perceive that they are not in a valued profession.

We believe that the new competency-based framework of psychiatric training, if robustly quality-assured, offers a solid opportunity to reassert the training needs of future psychiatrists, especially in regard to their unique medical expertise in the assessment and treatment of mental disorders. However, the current changes within mental health services threaten to undervalue our role as medical specialists. This is likely to further alienate medical undergraduates and compound the current recruitment crisis.

Urgent work needs to be done by our profession to re-engage with both the government and the public as a whole to ensure that the essential contribution psychiatrists make in providing a high-quality mental health service to our patients is not further devalued.