What has been the most rewarding achievement in your career to date?
I was involved in running the Royal College of Psychiatrists’ examinations from 1989 to 2005 and was chief examiner for four years (2002-2005). This role was rewarding because I contributed to the training and assessment of psychiatrists at a national level and influenced training and examination methods internationally during this period.
The NHS is in a state of flux, facing wholesale reforms drawn up by the coalition. What is your take on the White Paper?
There is a great risk that the NHS will become unrecognisable within 10 years and that there will follow fragmentation, extensive inequalities and variation in quality of service, and that ability to pay or make a contribution will determine what services an individual will receive. The ultimate dread is that mental health services will suffer most.
Are you confident that an improved NHS will be the result of the Government’s reforms, if approved by Parliament?
No. I am sceptical that the reforms will result in an improved NHS. I am sceptical, in any case, about progress as a political goal, particularly when measured by targets that tend to distort clinical practice. There is a real dilemma: health care budgets are inadequate for the task of providing universal and free care at the point of need and yet people do not want to pay more taxes. Gradual liberalisation of the system, coupled with disengagement of politics from micromanagement of the services may help. Definitely a moratorium on structural change at every turn will help.
How can GPs gain a better understanding of mental health issues?
GPs are trained to recognise and manage psychiatric disorders and indeed, the vast majority of people with emotional disorders are treated in primary care. Severe mental illnesses require time, patience and understanding. My own view is that these conditions are better served in secondary care.
Do you think GPs have a role to play in helping to tackle the stigma attached to mental illness, if so how can they work to address this issue?
Stigma is a complex problem that requires a multifaceted response. Part of the response is GPs modelling for others that mental illnesses deserve equal concern and treatment as compared to the so called physical illnesses. This is best exemplified by demonstrating respect for psychiatric patients and developing fair and equitable commissioning of mental health services.
