Commentary on the Great Western Road Medical Group Case Study

Published date01 September 1996
DOIhttps://doi.org/10.1108/13619322199600029
Pages24-25
Date01 September 1996
AuthorAlan Cohen
Subject MatterHealth & social care
24 The Mental Health Review 1:3 ©Pavilion Publishing (Brighton) 1996
evaluation of this model is developed some of these
questions might be answered.
Implications for primary care
In order to fully appreciate the major step forward
that this model represents, it is necessary to be
aware of the background against which it should
be set. General practice is at present attempting to
describe exactly what represents ‘coremedical
services’, the level of service provision that can be
expected from any practice in the UK. To this end,
the General Medical Services Council (GMSC)
produced revised guidelines in May 1996, setting
out what it feels to be the constituent parts of
‘general medical services’.
It is clear from the guidance issued to GPs by
the GMSC on mental health that the level of care
offered by this particular practice far exceeds the
minimum that can be expected. Were this model to
be taken up morewidely, it would have a financial
impact for the practice and the argument could be
made that there should be separate payments made
for the extra care being provided. This point is well
made in the paper itself when describing the
increased cost of providing personnel, and the
effect on the prescribing budget.
Is this model applicable to primary care? Are
other GPs likely to adopt such a way of working?
It would seem that the first prerequisite would be a
solid knowledge base in psychiatryand the manage-
ment of mental health problems. Unfortunately,
when only 15% of principals have had postgraduate
experience in a psychiatric post, and thereis a
dearth of continuing medical education events
around psychiatry,it seems likely that this rate
will not increase. While some will see this level of
knowledge as lamentable, it has to be pointed out
Alan Cohen, FRCGP, General Practitioner
CMHSD PRIMARY CARE ADVISOR
DrLawton’s paper describes how one practice
developed a method of working with other
groups to provide care for long-term
mentally ill people. His plan is to be applauded, as
is his dedication and that of his partners and practice.
Such a model of integrated care raises a number of
interesting questions that can be grouped around
four main categories:
implications for the patient;
implications for primarycare;
implications for secondary care;
implications for managers.
Implications for the patient
The paper describes the expectations of patients
who have recently been discharged from long-term
care; they have a high expectation of immediately
available medical advice and a high level of concern
about their own health. This is reflected in the high
consultation rate and use of the practice staff.
Interestingly, data on the use of the CMHT by
these patients is not provided.
It would appear that one of the outcomes of the
model described is the reduction in consultation rate
with GPs. While the GP might applaud this outcome,
it would be interesting to have data on the patients’
perception — is this outcome desirable or satisfactory?
The paper states that contact with GPs is now
appropriate and for medical reasons — is it that the
patients expected services that the GP was not in a
position to provide, arethe patients expectations no
longer being met, or has patient expectation been
changed? It would be hoped that as the formal
Commentary on the Great Western Road
Medical Group Case Study
COMMENTARY

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