Mental health teamwork in primary care

Abstract

The historical context is important when considering developments which are relatively recent and still in the process of being developed. Traditionally, general practitioners dealt on their own with their clinical workload but, following the doctor’s charter of 1965, there was a rapid move towards GPs working in group practices. This predated the concept of a primary health care team, but was associated with a rapid growth in the number of community nurses and health visitors with clear links with local GPs. The increase in formal and informal links with mental health professionals has been much slower, although this is currently a growth area. However, even now, it is important to remember how much variability there is in working arrangements; although the national average for single-handed general practitioners is 10%, it is much higher than this in many inner-city areas. Research over a similar time frame, i.e. the last 30 years, has established the range and extent of psychological morbidity presenting to primary care. There is now general agreement that 25± 30% of those attending their GP will have some psychological component to their presentation, and this means that the average GP with a list size of 2,000 patients will see an average of 460 patients per year with mental health problems (Goldberg & Huxley, 1992).