BMJ  2005;330:1122 (14 May), doi:10.1136/bmj.38440.418426.8F (published 20 April 2005)

Primary care

Patients' and health professionals' views on primary care for people with serious mental illness: focus group study

¹ Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham B15 2TT, ² Institute of Governance and Public Management, Warwick Business School, University of Warwick, Coventry CV4 7AL

Objective To explore the experience of providing and receiving primary care from the perspectives of primary care health professionals and patients with serious mental illness respectively.

Design Qualitative study consisting of six patient groups, six health professional groups, and six combined focus groups.

Setting Six primary care trusts in the West Midlands.

Participants Forty five patients with serious mental illness, 39 general practitioners (GPs), and eight practice nurses.

Results Most health professionals felt that the care of people with serious mental illness was too specialised for primary care. However, most patients viewed primary care as the cornerstone of their health care and preferred to consult their own GP, who listened and was willing to learn, rather than be referred to a different GP with specific mental health knowledge. Swift access was important to patients, with barriers created by the effects of the illness and the noisy or crowded waiting area. Some patients described how they exaggerated symptoms ("acted up") to negotiate an urgent appointment, a strategy that was also employed by some GPs to facilitate admission to secondary care. Most participants felt that structured reviews of care had value. However, whereas health professionals perceived serious mental illness as a lifelong condition, patients emphasised the importance of optimism in treatment and hope for recovery.

Conclusions Primary care is of central importance to people with serious mental illness. The challenge for health professionals and patients is to create a system in which patients can see a health professional when they want to without needing to exaggerate their symptoms. The importance that patients attach to optimism in treatment, continuity of care, and listening skills compared with specific mental health knowledge should encourage health professionals in primary care to play a greater role in the care of patients with serious mental illness.

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