As a consultant working in a tertiary service I see the results of New Ways of Working rather than participating directly myself. What emerges is a loss of diagnosis, let alone any attempt at a differential.

New Ways of Working assumes that it is easy to tell, at the moment of referral, whether or not a problem is complex or straightforward. In reality, overt psychosis can be relatively straightforward to spot but such individuals go to a psychiatrist. Left undiagnosed are complex personality disorder (borderline pathology reduced to ‘depression’) and subtle or unusual psychotic states such as encapsulated delusions or thought disorder, described as ‘normal’.

I have been involved in an increasing number of cases where there have been serious consequences of misdiagnosis, of the type that used to shame a part 1 candidate for MRCPsych. Diagnosis is still considered a fundamental part of medicine, so why have we, apparently willingly, opted out of this aspect of our medical discipline? I concur with those who worry about the demise of psychiatry - what is the point of a discipline that seemingly anyone can practice? The loss of differentiation between the disciplines does not contribute to egalitarian practice, it only leads to non-specific and perhaps unhelpfully focused treatment.