Job planning in psychiatry of eating disorders

• Lead on the comprehensive assessment of patients with eating disorders, offering specialist advice through consideration of differential and comorbid diagnoses, requesting appropriate investigations, and supporting the multidisciplinary team.
• As part of the multidisciplinary team, ensure patients receive evidence-based treatments such as enhanced cognitive behavioural therapy (CBT-E), family-based interventions, MANTRA (Maudsley Model of Anorexia Nervosa Treatment for Adults), or specialist supportive clinical management. The consultant psychiatrist provides clinical leadership and oversight of these interventions but will rarely deliver psychological therapy directly. They are responsible for formulating individualised care plans for complex patients, including consideration of alternative diagnoses where there is limited response to first-line treatment.
• Provide psychopharmacological assessment, prescribing, and monitoring where indicated.
• Assess medical and psychiatric risk and advise on safe management in collaboration with patients, carers, and relevant internal and external stakeholders.
• Assess and manage the physical health sequelae of malnutrition, including escalation to general medical and primary care colleagues where appropriate.
• Provide in-reach support to acute medical wards and general adult psychiatry wards to support the management of eating disorders in these settings.
• Demonstrate knowledge and appropriate use of mental health legislation in England or the devolved nations in the management of patients with eating disorders, providing clinical leadership in relation to ethical considerations and safeguarding.
• Prepare reports to support patients with eating disorders in relation to relevant legal frameworks, including Mental Health Review Tribunals, courts, and matters relating to social care, employment, education, training, and access to benefits.
• Work with the wider multidisciplinary team to ensure seamless transition from CAMHS to adult services, in line with national guidance for young people moving through services.
• Work collaboratively with the multidisciplinary team, including attending CPA meetings where appropriate, to support transition from inpatient to community care and reduce the risk of relapse following discharge.
• Provide specialist advice and guidance for the management of complex cases, including patients requiring intensive, compulsory, or multi-agency treatment.
• Contribute to the local implementation of national best-practice guidance, including NICE eating disorder guidelines.
• Work closely with families, carers, and people with lived experience of eating disorder services to support continuous quality improvement and service development.

• Provide clinical leadership in the development, implementation, and embedding of local good-practice guidelines and care pathways for eating-disorder services. Active engagement with relevant regional and national Royal College of Psychiatrists (RCPsych) bodies is encouraged.
• Lead liaison with managers and Experts by Experience to promote co-production and support service development, including pathways for the management of patients with eating disorders in acute hospitals and general adult psychiatry wards.
• Engage in regional discussions with commissioners and provider organisations to support the development, sustainability, and funding of eating-disorder services.
• Work in partnership with managers and commissioners to provide leadership on safe medical risk management, including community-based medical monitoring arrangements.
• Take an active leadership role within local and regional clinical networks to enhance understanding of eating disorders and promote collaborative working across professional groups, with a focus on improving quality and standardising care across services.
• Lead or supervise quality-improvement activity informed by patient- and carer-reported feedback, clinical outcomes, and service-level data.
• Contribute to a research-active culture by supporting recruitment to studies, contributing to publications, and encouraging engagement with research within eating-disorder services.
• Work with key stakeholders and commissioning organisations to identify and address health inequalities, including those related to ethnicity, gender, age, disability, and comorbidities such as autism spectrum conditions.

• Take an active role in undergraduate and postgraduate medical education, delivering teaching across all levels from medical students to higher specialist residents. Provide educational and clinical supervision to foundation, core, and higher psychiatry residents, and teaching to medical students, in line with Royal College of Psychiatrists standards.
• Deliver teaching and training to staff working within specialist eating-disorder services and other mental health teams to enhance knowledge and skills in the evidence-based assessment and management of eating disorders.
• Contribute to the education and training of staff working in relevant partner agencies, including primary care, acute trusts/health boards, and third-sector organisations, with the aim of reducing stigma and promoting awareness, early detection, diagnosis, and effective management of eating disorders.

Job planning for SAS psychiatrists should follow the same core principles as consultant job planning, in line with British Medical Association (BMA) guidance.

These principles include transparency, equity, recognition of all work undertaken, and a clear alignment between programmed activities and agreed responsibilities.

SAS psychiatrists should have job plans that are safe, sustainable, and reflective of their clinical contribution.

• There is wide variation in the staffing, configuration, and delivery of eating-disorder services across the UK. This variation is particularly evident between children and young people’s, adult, and inpatient services, both in staff background and staffing levels. While the principles of evidence-based treatment remain consistent, consultant recruitment and retention remain challenging. It is therefore essential that job descriptions include safe and manageable caseloads, and that trusts provide support for individual career development, including opportunities for research and senior leadership.
• Current guidance for consultant psychiatrist provision in children and young people’s community eating-disorder teams is 1.2 consultant psychiatrists per 100 annual referrals, or 4.5 consultant psychiatrists per 1,000,000 population (Access and Waiting Time Standard for Children and Young People with an Eating Disorder, NHS England, 2015).
• There is considerable variation in service design across adult eating-disorder services nationally. Given the inherent clinical complexity and associated physical and psychiatric risks, commissioners must ensure that services adhere to safe staffing levels. The faculty of eating disorders recommends the following 1.5 whole-time equivalent (WTE) community consultant psychiatrists per 1,000,000 population; however, this should be adjusted according to local referral rates. As a minimum, services should aim for 1.0 WTE consultant psychiatrist per 200 accepted referrals per year in a service that aims to treat a range of eating disorders.
• For inpatient eating-disorder services, consultant psychiatrists should be allocated 10 programmed activities (PAs) per 12 beds. This allocation does not account for the additional workload associated with recent Mental Health Act reforms, which are expected to significantly increase the administrative and statutory demands for detained patients. The implementation of these reforms will require an increase in medical or approved clinician provision.
• The required consultant psychiatrist time will vary depending on the skill mix, accessibility, and experience of the multidisciplinary team. This includes access to physical health nurses, general practitioners, psychologists, residents, and administrative support, in addition to specialist eating-disorder practitioners and dietitians. In practice, however, such comprehensive support is often limited, particularly within community services.
• A full-time (10 PA) consultant psychiatrist post should typically comprise 7.0 PAs of Direct Clinical Care (DCC)and 2.5 PAs of Supporting Professional Activities (SPA).