'Referral into a void': opinions of general practitioners and others on single point of access to mental health care.
In the past, British general practitioners (GPs) have referred patients to individual consultants. There is now a trend towards generic referral, whereby the specialist team is consulted via a single point of access. We examined the impact of this innovation on the relationship between GPs and specialists in mental health care. Sixteen groups of randomly selected GPs and mental health professionals (MHPs) in England discussed clinical scenarios involving the use of mental health interventions for patients with functional somatic symptoms. The meetings were audiotaped, transcribed and analysed to the point at which no major new themes were emerging. The final analysis was confined to a purposive sample of six of the sixteen groups, comprising 54 GPs and 15 MHPs. Although the rationale for the single point of access was clear to both GPs and MHPs, the approach erected boundaries because it impeded the establishment of professional relationships and transfer of knowledge. GPs thought the system reduced their capacity to be accountable to their patients and limited the potential for their own professional development. MHPs did not seem to be aware of GPs' concerns. Effective interprofessional management of individual patients depends upon confidence in colleagues' skills and good communication. Factors that hamper these must be addressed in the development of this system of referral.
Raine
Rosalind
R
Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK. rosalind.raine@lshtm.ac.uk
Carter
Simon
S
Sensky
Tom
T
Black
Nick
N
D001291:Attitude of Health Personnel; D004739:England; D005194:Family Practice / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration*; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D012017:Referral and Consultation / Q000458:organization & administration*