The role of the general practitioner in severe mental illness

Around 25% of patients with severe enduring mental illness (SEMI) lose contact with psychiatric services and are looked after entirely in general practice, so it is 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 diseases 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. The National Service Framework recommended that practices produce a register of patients, to ensure that regular reviews are carried out, including both mental and physical health problems. Since 2003, the UK GP contract has awarded practices money to produce a register and carry out regular reviews of SEMI patients. Practices can set up registers easily, using repeat prescribing data and computer diagnostic labels. Regular reviews should include a check on symptoms, medication, physical health and coordination arrangements with secondary care. In the UK, practice computer systems now provide a template for recording regular reviews, to enable practices to meet their contract targets.