What to do if your GP refuses to refer you for CBT

This page first appeared in the OCD-UK magazine, Compulsive Reading in October 2010. Written by Stephanie Fitzgerald, Trainee Clinical Psychologist.

First approaching your GP The first time you approach your GP is important (don’t worry if you’ve already been to see your GP – there’s always a second chance). GPs work on a time-limited basis and this can make you feel pressured. If it would make you feel more comfortable you can ask for two appointments back-to-back, in order to have more time with your GP.

When you see your GP you need to be as informed, clear and focussed as you can be. You need to be able to tell your GP the exact extent to which OCD is affecting your life in as much detail as you can. This can be particularly hard but this is not the time to be shy or embarrassed and there is no place here for British reserve. Do not play down your symptoms in any way – your GP will need to know the full extent of the problem in order to help you. If this feels challenging face-to-face then write it down and post it to them prior to your appointment. This way they know what to expect from the appointment and can do some research beforehand. Draw on whatever resources you can – if there is someone close to you who understands and can help you to explain the situation to your GP then take them with you. Do whatever you can to make it easier for yourself.

If you are offered medication but wish to undergo therapy instead, try and be clear as to your reasons why. GP’s may not be sympathetic towards those who ‘just don’t like taking tablets’ so try and be clear. Perhaps explaining that OCD is an anxiety disorder and so you would like therapy to help you learn some anxiety management techniques is a GP-friendly way of explaining your preference for CBT.

What if they say no? Go to another GP. Very few people realise that you are a patient of the practice and not of your GP and that you are therefore entitled to ask to see another GP in the practice. Ask the practice which GP specialises in anxiety disorders and make an appointment with them. Do not worry that you will offend your GP. You are well within your rights as an NHS patient to see as many GP’s as you wish and many people ask for second opinions about many different problems. If you are worried about maintaining a good relationship with your GP, my advice would be to keep them informed of what you are doing and why, although you are under no obligation to do so.

What if they still say no? Still no luck? Ask the practice manager for the name of your local Primary Care Trust (PCT) who provides the funding for the GP practice. Under the Freedom of Information Act you are entitled to this information, however if your practice manager is not forthcoming then you can find out this information online or at your local Citizens Advice Bureau or local library.

Once you have the details for your PCT get in touch and explain your situation. Under your right to choose as an NHS patient explain that you have expressed a preference for CBT and have been refused. As the body responsible for funding your GP practice ask them what they can do to help. Nine times out of ten the PCT is likely to phone your GP and tell them to give you the referral – PCTs don’t like to be seen as ineffective!

Don’t be put off if your GP quotes you a two year waiting list – it seems to be a favourite line for GPs everywhere! Therapy waiting lists constantly shift and if your OCD is severely impacting on your life you are likely to be moved up the waiting list as a priority. I have seen people as quickly as two weeks after their initial referral so it is well worth joining the waiting list and pursuing this option. OCD-UK would be able to help you make contact with your PCT if you feel you need additional support.

Still being refused? Don’t panic! There are still plenty of options.

If your PCT cannot get the GP to refer you for therapy, you can ask your GP/ PCT to refer you to the Mental Health Team for a second opinion. The MHT will be able to provide you with a diagnosis and directly refer you to therapy from there. The PCT can also provide you with details of your nearest Improving Access to Psychological Therapies (IAPT) centre, most of which have a self-referral route meaning you won’t need to involve your GP at all.

Still no? Time to forget your GP! Going private is an option. People are often put off approaching the independent sector due to fears about prohibitive costs, but there are many services that work on a means tested or donation basis, meaning you only pay what you can afford. Your local Citizens Advice Bureau or library will have information about these services.

If you cannot get access to these services, or you want to be seen sooner, then independent sector therapy is an option. It may be worthwhile paying for a private assessment in order to receive a diagnosis with which you can re-approach your GP/PCT at a later stage. If you are considering the independent sector then find a therapist through the BABCP to make sure they are suitably qualified in CBT and don’t be afraid to negotiate your fees.

A rough guide for private therapy is between £45 and £85 per session. Some therapists charge a lot more and it is area dependent, with London being a particularly expensive area, so be sure to decide on your own upper limit and negotiate your fees with your therapist – most are more than happy to accommodate (and if they are not then they are not the therapist for you!). Take time to chat to your therapist on the phone prior to committing to paying for therapy. You need to trust them in order to feel comfortable talking to them and you need to feel confident that they can help you. The finding a good therapist feature on this website is a good starter to help you find a good OCD therapist.

Other options? Whilst waiting for therapy there are many ways you can help yourself. There are some incredibly useful self-help resources out there and you have taken an important step by making contact with OCD-UK, who can provide you with support and information as well as offer you details about your local support groups and OCD-UK events.  You do not have to face this alone.

Taking the next step… I am aware in writing the above that some of these options are not easy. They require energy and perseverance at a time when you possibly feel at your most low and vulnerable. If you feel too unwell to take these steps then ask someone who understands your situation to help you. If you have not told anyone about your OCD then contact your local Patient Advice and Liaison Service (PALS) and they can negotiate and campaign on your behalf.

I suppose above all else, the message is DON’T GIVE UP!

Your have many options and rights as an NHS patient so use them to get the treatment you deserve. Remember: your choices do not end with your GP…

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