Intended for healthcare professionals

Letters Fallout from rise in private referrals

Private practitioners should treat, not just assess

BMJ 2022; 377 doi: (Published 18 May 2022) Cite this as: BMJ 2022;377:o1247
  1. Quentin Spender, consultant paediatric psychiatrist
  1. Oxford Youth and Family Practice, Oxford, UK
  1. quentin.spender{at}

I agree with Salisbury on the fallout from the rise in private referrals.1 As a private practitioner in child and adolescent psychiatry, I believe I have the privilege of criticising my kind.

If we assess, we should treat, and if we treat, we should continue treating. Therefore, I would not make an assessment and then expect a GP to prescribe outside their competence; I would prescribe myself. This might mean transferring my patient to my concessionary rates, which most of my client families can afford, or occasionally doing the work free. Once I start prescribing, I have a duty of care to continue doing so, whether I am paid or not. Others would probably disagree.


  • Competing interests: I might stand to gain clients from this comment, if any potential clients read The BMJ, but I am so inundated at the moment that I have had to close to all referrals until at least next year.


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