Primary care by the psychiatric team

There are four ways in which a psychiatric team can work with the primary care team.

Advice and train general practitioners and their staff:

In this style of working, the psychiatrist and other members of the team do not see patients but give advice based on the general practitioner's assessment of patients. The psychiatrist may also hold seminars or case discussions with the primary care staff. This arrangement increases the skills of the members of the primary care team, thus making them more effective in treating similar patients in future. The psychiatric nurse may work similarly with the practice nurses who can play an important part in treating psychiatric disorder.

Assess patients

The psychiatrist assesses patients when the general practitioner is uncertain about diagnosis or treatment. He may do this on his own or jointly with the general practitioner. Patients identified as needing specialist treatment are then referred to a psychiatric our-patient clinic in the usual way.

Assess and treat patients

The psychiatrist works mainly in primary care, seeing most patients at the primary care centre or at home, rather than in the hospital out-patient clinic. Clinical psychologists and psychiatric nurses also work in primary care, providing assessment, counseling, or behavioral treatment. Patients no longer need to visit a psychiatric clinic, but there maybe little contact between the psychiatric and primary care teams.

Shared Care

This approach fits with the care plan approach used for patients with severe mental illness, but it is not restricted to this group of patients. The general practitioner and the leader of the psychiatric team agree how each team will contribute to an overall plan of management, and a key worker is appointed.

The most appropriate arrangement depends on the needs of the general practitioners, the accessibility of hospital out-patient clinics, and the number of primary care centers in which the psychiatrist works.

Agreeing priorities in primary core

There is debate whether members of the community psychiatry team should accept referrals direct from the general practitioner, or whether referrals should be screened and prioritized by the leader of the psychiatric team leader in order to maintain the team's focus on patients with serious mental disorder. Without screening, community psychiatric nurses may take on large numbers of patients with minor disorders for whom their work may not be cost-effective. To avoid conflict, priorities and referral procedures should be agreed at the start of the collaboration between the primary care providers and the community psychiatric team.