title: The role of primary care in service provision for people with severe mental illness in the United Kingdom.
abstract: BACKGROUND
  Severe mental illness is a serious and potentially life changing set of conditions. This paper describes and analyses patient characteristics and service usage over one year of a representative cohort of people with a diagnosis of severe mental illness across England, including contacts with primary and secondary care and continuity of care.
  
  
  RESULTS
  Data were collected from primary care patient notes (n = 1150) by trained nurses from 64 practices in England, covering all service contacts from 1(st) April 2008 to 31st March 2009. The estimated national rate of patients seen only in primary care in the period was 31.1% (95% C.I. 27.2% to 35.3%) and the rates of schizophrenia and bipolar disorder were 56.8% (95% C.I. 52.3% to 61.2%) and 37.9% (95% C.I. 33.7% to 42.2%). In total, patients had 7,961 consultations within primary care and 1,993 contacts with mental health services (20% of the total). Unemployed individuals diagnosed more recently were more likely to have contact with secondary care. Of those seen in secondary care, 61% had at most two secondary care contacts in the period. Median annual consultation rates with GPs were lower than have been reported for previous years and were only slightly above the general population. Relational continuity in primary care was poor for 21% of patients (Modified Modified Continuity Index = <0.5), and for almost a third of new referrals to mental health services the primary care record contained no information on the referral outcome.
  
  
  CONCLUSIONS
  Primary care is centrally involved in the care of people with serious mental illness, but primary care and cross-boundary continuity is poor for a substantial proportion. Research is needed to determine the impact of poor continuity on patient outcomes, and above all, the impact of new collaborative ways of working at the primary/secondary care interface.
authors.affiliation: National Institute for Health Research School for Primary Care Research, Health Sciences Research Group, University of Manchester, Manchester, England, United Kingdom.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Reilly
authors.forename: Claire
authors.initials: C
authors.lastname: Planner
authors.forename: Mark
authors.initials: M
authors.lastname: Hann
authors.forename: David
authors.initials: D
authors.lastname: Reeves
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.forename: Helen
authors.initials: H
authors.lastname: Lester
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D012720:Severity of Illness Index; D006113:United Kingdom