I strongly agree with the recommendation of the recently published NICE guideline on schizophrenia that good liaison between primary care and secondary services is a priority (Clinical Guideline 1. Schizophrenia - Core interventions in the treatment and management of schizophrenia in primary and secondary care).
Liaison is not, I feel, good in the Furness area where I work; there is no opportunity for regular meetings between GPs and the community mental health team. It was illuminating that, at a recent CMHT meeting I attended, the CMHT leader expressed the opinion that GP mental health referrals should be directed to a common point of referral. The CMHT should then meet to decide on an appropriate response, with the referring GP being the one person to be - conspicuously - absent from these meetings.
When I worked in Oldham, our practice participated in a pilot study in which a liaison psychiatrist regularly visited the practice, and I found that this provided a valuable forum in which to discuss problem cases.
My present practiceês •severe and enduring mental illnessê case register provides the infrastructure to enable us to offer our schizophrenia patients regular physical health checks, as the guideline recommends (see News, December 2002). However, I would wish to carry out an audit of our current care (recording BMI, CHD risk factors, prolactin measurements and monitoring drug side-effects) before deciding to implement these checks.
As the guideline states, it should also be clearly agreed between primary and secondary care where the –responsibility for assessing and monitoring the physical health care needs of service users” lies. This takes us back to the problem of inadequate liaison between primary and secondary care.
Dr Phillip Bland, GP, Dalton-in Furness