Primary care for severe problems

Primary care is key to changing the high rates of physical illness amongst people with severe problems and promoting recovery.

Two thirds of people with severe problems are seen by a combination of primary and specialist services and a third only in primary care:

  • Annual GP consultation rates for the latter in a recent study were 3 per annum compared to 2.8 for the general practice population as a whole59.
  • Practice nurses, with a key role in cardiovascular risk screening and health education, consulted with this population about once a year on average compared with the population rate of 1.8 consultations per year59.
  • Problem-based interviewing had a positive effect on the detection and management of common mental health problems presenting in primary care60-62. Evaluation of training primary care physicians to manage severe problems in the community suggested that this increased referral rates to secondary care63 whilst a further study saw no effect64.
  • Placement of social workers in primary care can be successful65 but mental health facilitators or ‘hand-held’ records shared between primary and secondary care seem not to be61
  • People with common mental disorders improved markedly overall whether referred to community nurses trained in problem solving or for their usual care or not66
  • Collaborative care between primary care, psychiatrists and care managers does have demonstrable efficacy in common mental disorders67