Failure to remunerate doctors carrying out mental health assessments adequately is straining health services and potentially jeopardising patient wellbeing, the BMA has warned.

MHAAs (Mental Health Act assessments) generally with few exceptions fall outside of the terms of service for GPs and the terms and conditions of service for consultants and other salaried NHS doctors including specialty doctors.

Payments provided to doctors trained to perform assessments of patients under the Mental Health Act have failed to keep pace with rising costs, resulting in shortages of staff able to carry out this vital work, according to the BMA professional fees committee.

Assessments, which are carried out under section 12 of the Mental Health Act, are conducted by consultants, specialist, associate specialist and specialty doctors, resident doctors and GPs who have undergone relevant additional training.

These assessments, which can take place out of hours and in a range of locations including homes, hospitals and police stations, are used to determine whether a patient experiencing a mental health crisis should be detained in hospital.

Despite the important nature of the work, PFC claims assessment fees have remained largely unchanged for two decades and failed to take account of inflation or rising costs.

Fees offered by local authorities for MHAAs demonstrate significant regional and local variation, creating unnecessary confusion and complexity for the doctors conducting the assessments and those responsible for their provision.

In certain cases, fees have remained the same for up to 20 years despite inflation and cost-of-living pressures.

The committee has also warned that, with fee rates set by local authorities in England, remuneration offered to medical staff can vary from a flat fee of £300 to as little as £170.

BMA professional fees committee chair Rob Barnett said his committee was preparing to survey doctors involved in mental health assessments, to gain a deeper understanding of the scale of the challenges posed and lobby for change.

He added that the failure to increase assessment fees coupled with the postcode lottery based on local authority was disincentivising many doctors from taking on highly complex and challenging but essential work.

He said: ‘Mental health assessment fees have remained stagnant for a long time and rarely take into account the time taken to do some of this work. Sometimes assessments take place in an out-of-hours period and the work is becoming increasingly more complex.

‘When you are depriving someone of their liberty, invariably against their own wishes, we need to ensure that there are enough appropriately trained and paid doctors. If the pool of doctors decreases, then the few that are left will be become even more and more stretched.’

An assessment under the Mental Health Act requires multiple staff including a Section 12 trained doctor, a qualified social worker and another doctor to provide a second opinion of the assessing doctor’s decision.

In this way, doctors and social workers come to a jointly made decision about whether someone needs to be either admitted under the Mental Health Act.

As a Section 12 approved doctor, consultant forensic psychiatrist John Moore regularly undertakes assessment work, a role he says has become ever more challenging.

He said: ‘In lots of parts of the country, the fees for Mental Health Act work for being that second opinion doctor have not increased for close on two decades at this point. As a result, people have become increasingly reluctant to come out and do that work.

‘When there’s inevitably fewer people available to do the work, it means massive backlogs and delays in the patients receiving the definitive care that they need.’

Citing travel costs and the burden of indemnity insurance, the cost of which is barely covered by the fees for assessment work, Dr Moore warns that failure to address stagnant fees will ultimately harm patients and the wider NHS.

‘It is frequently the case that assessments that should happen overnight don’t because you can’t get hold of a second-opinion doctor,’ he says.

‘There have been times when I might be asked to assess a patient, perhaps an acutely psychotic person in A&E, but because I can’t get hold of a second-opinion doctor at 4am, the requests just go unanswered.’

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