The role of the general practitioner in severe mental illness

Abstract

Around 25–30% of patients with severe and enduring mental illness (SEMI) lose contact with psychiatric services and are looked after entirely in general practice, so it is very important that primary care teams understand their problems and know where to seek help. GPs and practice nurses also have a very important role to play in the physical care of patients with SEMI. High rates of smoking and obesity, and the side-effects of psychotropic drugs, mean that these patients are at increased risk of developing heart disease, chronic obstructive lung disease and diabetes. Mortality rates from cardiovascular and respiratory are more than doubled in schizophrenia. Regular structured assessments of SEMI patients in general practice have been shown to improve the process and outcome of care. Joint GP and nurse assessments probably work best, in special clinical sessions rather than in routine surgery appointments. The National Service Framework for Mental Health recommended that practices produce a register of patients, to ensure that regular reviews are carried out, and including both mental and physical health problems. The new contract for GPs in the UK awards practices money if they produce a register and carry out regular reviews of SEMI patients. Practices can set up registers easily, using repeat prescribing data and other information. Regular reviews should include a check on the accuracy of prescribed medication, a review of physical health, a review of coordination arrangements with secondary care. Special records can be used to keep track of patient reviews for audit purposes. Alternatively, practice computer systems often provide a template for recording regular reviews.