The survey of psychiatric trainees in Scotland by Dr Robinson (Psychiatric Bulletin February 2005, 29, 62-64) showed that a significant amount of physical healthcare is being provided by psychiatric trainees.

In my experience, south of the border the situation is no different, particularly in psychiatric long-stay facilities such as rehabilitation units and forensic units where a large degree of physical morbidity exists. Cormac et al (2004) reported high rates of avoidable health risks such as smoking, obesity, central weight distribution and excessive weight gain.

The role of the trainee is to identify and manage problems for which they often may have received no formal training. After completion of pre-registration house jobs, direct entry to psychiatric training schemes is not uncommon. The notion of managing, for example, an individual's diabetes, hypertension or obesity may be quite alien never mind being able to recognise strange skin complaints and other problems commonly encountered in primary care.

I have experience and training in primary care which I have found invaluable in dealing with my patients’ physical health problems. The National Service Framework for Mental Health requires health promotion and appropriate access to and delivery of primary care for patients with mental disorders (Department of Health, 1999). It may be of value to consider the training needs of psychiatric trainees with regards to management of physical health problems.