The British journal of general practice : the journal of the Royal College of General Practitioners
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In this paper, we argue that mental illness touches everyone's lives, and that mental health care is a core activity of primary care. The increasing move towards a primary care-led National Health Service has now created a climate where primary care can move beyond providing a gatekeeper function for secondary care specialist services. ⋯ We discuss examples of integrated approaches to mental health care, and highlight the potential tensions created by new ways of working. We also suggest that any changes need to be accompanied by carefully negotiated adjustments to the way primary and secondary healthcare professionals conceptualise their roles and responsibilities, and must be underpinned by new ways of learning together.
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Despite generally falling mortality and suicide rates, among young men the rates of violent death from accidents and suicide continue to rise. Most research has focused upon suicide, and the potential for effective interventions, particularly in primary care, remains controversial. ⋯ These findings confirm that relatively few young men consult their GP during the period before death from suicide or accidents. Prevention strategies must extend beyond suicide risk assessment, and consider ways to encourage young men to consult GPs when they are experiencing emotional distress or problems related to mental health or substance misuse.
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Nurse management of minor illness is a common method of demand management in primary care. Delegation of minor illness management to nurses may result in a change in patients' presenting problems and the consequent consulting behaviours of general practitioners (GPs). ⋯ Delegating the management of patients with minor illness to nurses in a telephone triage system may result in an overall increase in the number of presenting problems per patient, as well as changing GPs' consulting behaviours. Appointment systems may have to be adjusted to ensure patients receive more GP time. Further work on developing measures of complexity and controlled studies of the impact of new working arrangements on workload in primary care are required.
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Symptomatic investigation and treatment of unexplained physical symptoms is often attributed to patients' beliefs and demands for physical treatments. ⋯ Patients with unexplained symptoms present opportunities for GPs to address psychological needs. By taking these opportunities, GPs might be able to avoid unnecessary symptomatic intervention.