Intended for healthcare professionals

Primary Care

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

BMJ 2005; 330 doi: (Published 12 May 2005) Cite this as: BMJ 2005;330:1122
  1. Helen Lester, national primary care career scientist (H.E.Lester{at},
  2. Jonathan Q Tritter, director of research health strategy and management2,
  3. Helen Sorohan, research fellow1
  1. 1 Department of Primary Care and General Practice, Medical School, University of Birmingham, Birmingham B15 2TT,
  2. 2 Institute of Governance and Public Management, Warwick Business School, University of Warwick, Coventry CV4 7AL
  1. Correspondence to: H E Lester
  • Accepted 23 March 2005


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.


  • Contributors This study was funded as part of HEL's national primary care career scientist award. HEL conceived the idea and designed the study, conducted each of the focus groups, analysed the data, and drafted the paper. JQT analysed the data and critically revised the paper. HS helped to run most of the focus groups, was responsible for liaising with local patient groups, for conducting the postal respondent validation, and for critically revising the paper. HEL is the guarantor of the paper.

  • Funding None.

  • Competing interests None declared.

  • Ethical approval Ethical approval was granted by the West Midlands Multicentre Research Ethics Committee.

  • Accepted 23 March 2005
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