• Lorrie Symons, André Tylee, Anthony Mann, Roger Jones, Susan Plummer, Maria Walker, Carole Duff, and Rebecca Holt.
• Warwick House Medical Centre, Taunton.
• Br J Gen Pract. 2004 Sep 1; 54 (506): 679-83.

BackgroundResearch has identified a need for improved depression care in primary care, while current United Kingdom (UK) health policy outlines standards for the management of the condition, including improved access to care. Innovative ways of working are needed to address these standards and provide better care.AimsTo pilot a multidisciplinary service for the management of depressed patients with a particular focus on facilitating access.Design Of StudyUncontrolled descriptive pilot study.SettingOne general practice in inner London.MethodsThe service was advertised by post to all 6689 adult patients registered with the practice. It provided open access and face-to-face assessment by a specially trained primary care nurse for patients who considered themselves to be depressed. Following assessment, depressed patients received systematic telephone support from nursing staff in addition to the usual care from the general practitioners (GPs). The ser vice was evaluated for a 6-month period.ResultsSixty-six people, aged 19-77 years, 44 of them female, contacted the service, the majority in the first 2 months. Fifty-four patients were offered an assessment by the nurse. Thirty-five (80%) of the 44 attendees fulfilled criteria for major depression. Between them, the nurses and doctors achieved high levels of adherence to treatment and follow-up. This specialist service appears to have enabled a group of depressed patients, some of whom may not have sought or received help, to gain access to primary care. With appropriate supervision and training in depression care the nurses were able to assess and support depressed patients and this appeared to be acceptable to both patients and GPs.ConclusionIn its present form the service would not be cost-effective. However, we believe it could be adapted to suit the needs of individual or clusters of practices incorporating key elements of the service (open access and case management, in particular), and further evaluation by a controlled trial is suggested.

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