How to develop and maintain a role in child and adolescent mental health

Essential qualifications:

• Full GMC Registration (with Licence to Practise).
• Certificate of Completion of Training - Certificate of Prescribed Experience from JCPTGP or equivalent.
• Registered on both the GMC and GP Registers.
• Evidence of continuous professional development relating to CYP mental health care and associated comorbidities.

Desirable qualifications:

• MRCGP (or equivalent). 
• Postgraduate education in CYP mental health from a recognised provider.
• Postgraduate placement and education within a team delivering CYP mental health services, evidencing external assessment of adequate competencies in care.

Factors to be considered and practical steps that can be taken to encourage greater sustainability and reduce the environmental impact of work in this area include:

• Implementing evidence-based and cost-effective interventions that are tailored to the individual’s needs and circumstances, and that aim to improve their outcomes and reduce their reliance on medication and other resources.
• Promoting the clinically appropriate use of digital and online platforms for delivering services, such as telehealth, e-learning, and e-prescribing, that can reduce the need for travel, paper, and physical infrastructure.
• Applying the principles of green prescribing, which involves recommending activities that involve contact with nature - such as gardening, walking, or cycling - that can benefit the physical and mental health of CYP and their families, as well as the environment.
• Engaging in collaborative and multi-disciplinary work with other professionals, organisations and stakeholders that can share best practice and resources for improving the quality and efficiency of services and in doing so, foster a culture of sustainability and environmental awareness.

The GPwER CAMH can ensure inclusivity by means of the following:

• Recognising the diversity and heterogeneity of CYP with mental health conditions, and how their symptoms and needs may vary depending on their age, gender, ethnicity, culture, socio-economic status, co-occurring conditions, and other factors.
• Providing culturally sensitive and competent care, that respects the values, beliefs, and preferences of CYP and their families, and that addresses the potential barriers and challenges they may face in accessing and engaging with services.
• Adopting a strengths-based and positive approach, that acknowledges the skills and qualities of the CYP, and how to harness these to support their talents and achieve their goals.
• Collaborating with CYP and their families, carers, and advocates, and involving them in the decision-making process about their assessment, diagnosis, and treatment, as well as in the evaluation and improvement of services.
• Promoting the awareness and understanding of CYP mental illness among other professionals, organisations and stakeholders to reduce stigma, and advocating the rights and needs of people with mental ill health in various settings, such as education, employment, health and justice.

To demonstrate capabilities associated with the extended role, we have taken the five areas of capability described in the RCGP curriculum as a starting point. These are based around the GMC's generic professional capabilities framework.

1. Knowing yourself and relating to others

• change management
• driving performance/performance management
• motivating and inspiring
• coaching and decision-making
• collaboration and partnership working
• influencing, negotiating, compassionate leadership, mentoring
• communication and team building.

2. Applying clinical knowledge and skill

• shared decision-making
• managing risk
• using a biopsychosocial approach
• Co-ordinating care.

3. Managing complex and long-term care

• provide face-to-face (or virtual) consultations with patients requiring GP input which may involve providing extended appointments and/or home visits
• understand clinical governance and professionals' accountability
• provide a comprehensive assessment of a person's needs 
• settings for assessments can include the patient’s home, surgery, education, or hospital
• share relevant information amongst teams involved in the person's care in dedicated time
• may support other GPs to manage CYP with mental health difficulties
• may develop patient-specific care plans and treatment escalation plans. May manage these patients on behalf of their registered GPs.

4. Working well in organisations and systems

• may undertake assessments independently or with other members of the team.
• may manage complex care patients in the community on behalf of their GP
• may support a GP or other CAMHS specialist in managing patients 
• communicate and build relationships on an individual, multi-professional and team basis with all levels of staff
• enable collective responsibility
• work autonomously
• oversee management, reporting, and analysis
• may provide a link between medical services, education or social services and GP.

5. Caring for the whole person, wider community, and the environment

• may provide or oversee care on behalf of a cluster or primary care network
• may lead a multi-disciplinary team
• maintain an awareness of other resources available for CYP with mental health difficulties, including local resources and non-pharmacological approaches.

The GPwER CAMH should have an appropriate balance of practical and theoretical knowledge in relation to their extended role. Refer to the RCGP Guide to GP Clinical Extended Roles (PDF file, 440 KB) for further information. 

GPs looking to work with an extended role in CAMH can acquire additional experience and knowledge through several strategies to enhance their understanding and competence in managing CYP with mental health problems. Potential sources of professional development are listed here:

• Specialised training, courses workshops: Participate in specialised training programs, it is recommended that course(s) or workshops focus on CAMH diagnosis, treatment, management, and understanding the unique needs of CYP with mental health problems.  
• Continuing Medical Education (CME) events: Attend CME events, conferences, and seminars related to CAMH. These events often feature expert speakers, the latest research updates, and practical insights into CAMH assessment and management.
• Online learning platforms: Utilise online platforms that offer courses and modules on CAMH, diagnoses, evidence-based treatments, and strategies for managing mental health difficulties in CYP. The RCGP eLearning website offers educational material which can support this.
• Collaboration with specialists: Collaborate with psychiatrists, psychologists, neurologists, and other specialists to gain insights into their expertise and approaches in diagnosing and managing CAMH. Shadowing or participating in joint consultations can be immensely beneficial.
• Peer learning and discussions: Engage in discussions and knowledge-sharing with peers, especially those who already work with CAMH patients, or allied areas. Learning from their experiences and insights can enhance understanding.
• Mentorship and supervision: Seek mentorship or supervision from experienced GPs or specialists in CAMH. Regular meetings with a mentor can provide guidance, feedback, and opportunities to discuss complex cases.
• Participate in research and studies: Engage in research related to CAMH or clinical trials involving treatments for CYP. Active involvement in research can deepen your understanding and keep you updated with the latest advancements.
• Join professional associations: Become a member of professional organisations related to CAMH. These organisations offer access to resources, conferences, and networking opportunities.
• Subscribe to journals and publications: Subscribe to reputable journals and publications specialising in CAMH research and clinical practice. Regular reading helps GPs to stay informed about the latest research findings and best practices.
• Participate in workshops and webinars: Attend workshops and webinars specifically focused on CAMH, hosted by reputable organisations or institutions. These events often cover various aspects of CAMH management and provide opportunities for interactive learning.
• Case conferencing and reviews: Engage in case conferencing or case reviews with colleagues to discuss complex CAMH cases, exchange ideas, and learn from each other's experiences.
• Hands-on clinical experience: Actively involve yourself in the assessment and management of CAMH cases within your practice. Seek referrals for assessments, collaborate with specialists, and apply evidence-based approaches to treat CYP with mental health problems.

By actively seeking out these educational and experiential opportunities, GPs can enhance their skills, knowledge, and confidence in managing CAMH problems.

The GPwER CAMH necessitates a unique approach to leadership, distinct from a standard GP role. This is evident through the lens of the RCGP Leadership Capabilities Framework, particularly focusing on the following domains:

Demonstrating personal qualities

The GPwER CAMH must embody heightened personal qualities of empathy, patience, and understanding, recognising the complexities of mental health problems in CYP and their impact on individuals' and families’ lives. This role demands a deeper understanding of mental health conditions, necessitating adaptability, resilience, and the ability to manage uncertainty and diverse patient needs effectively.

Working with others

Collaborative and multidisciplinary teamwork is fundamental for GPs in an extended CAMH role. Interacting with psychologists, psychiatrists, educators, and support groups is crucial for a holistic approach to CAMH management. GPs need to effectively communicate, delegate, and co-ordinate with these stakeholders, fostering a seamless network of care to meet the unique requirements of CYP with mental health problems.

Managing services

Managing services in the context of extended CAMH roles involves developing efficient care pathways and service models. GPs need to design systems that facilitate easy access to assessments, referrals, and treatment. Optimising workflows and resource allocation is essential to streamline CAMH care, ensuring timely interventions and minimising bottlenecks in the system.

Improving services

Leadership in extended CAMH roles entails a proactive approach to continuous improvement. GPs should engage in quality improvement projects, data analysis, and feedback mechanisms to enhance services. Incorporating feedback from patients and stakeholders is essential to tailor services, implement evidence-based practices, and address gaps in care effectively.

Setting direction

GPs leading in extended CAMH roles must set a clear strategic direction. This involves envisioning a comprehensive, patient-centric CAMH service that integrates seamlessly with existing healthcare structures. Establishing goals, priorities, and objectives aligned with improving CAMH care and advocating necessary resources are pivotal aspects of setting the right direction.

In summary, leadership in an extended CAMH role demands a heightened focus on empathy, interdisciplinary collaboration, efficient service management, continuous improvement, and strategic vision. These attributes are essential to navigate the complexities of CAMH care, drive positive outcomes, and shape a holistic approach to managing CAMH within the primary care framework. 

The RCGP's position is that GPs are expert medical generalists and, as such, do not need formal accreditation in enhanced roles for which they have been trained. However, where formal accreditation is desired by a GP, programmes that offer accreditation should be made available. Refer to the RCGP Guide to GP Clinical Extended Roles (PDF file, 440 KB) for further information.

As for all doctors, GPs are required by the GMC to recognise and work within the limits of their competence and should refer to the GMC's Good medical practice for a description of what it means to be a good doctor.

It is worth noting that employers and service commissioners may have specific requirements relating to the provision of a GPwER service.

The evidence that a GPwER is keeping their requisite knowledge and skills up to date and maintaining their competencies should be reviewed through the GPwER's annual whole scope of practice appraisal. This should form part of the discussion of all external roles. Including quality improvement activity such as case analysis and audit. This has replaced any need for periodic re-accreditation. Please refer to the RCGP Guide to GP Clinical Extended Roles (PDF File, 440 KB) for further information.