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 care^60-62. 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