A General Practitioner's Guide to Managing Severe Mental Illness is described as a booklet for busy general practitioners (GPs) and primary health care teams. Short, snappy and pragmatic at 22 pages with a couple of Martin Davies cartoons to brighten up the text, it is based both on common sense and an increasingly robust evidence base. The structure is logical and the content grounded in the reality of general practice so that workload issues as well as the mechanics of developing more structured services are discussed. There is also a healthy emphasis on care pathways and, in theory, a ‘user perspective of the service provided’ although the latter seems to me to be sadly missing. There is, for example, no debate about the ethical and philosophical dilemmas inherent in the creation of practice registers, the possibility and consequences of indefinite registration, and the impact this might have on notions of recovery (Reference Barr and CotterillBarr & Cotterill, 1999). Overall, however, this is a useful and timely guide, with the advent of the new General Medical Services GP contract (with 23 points for developing and delivering more structured care for people with serious mental illness) making it a ‘must-have’ for every practice.
Political zeitgeist can, or course, work both ways; although Setting the Standard was published in the same year, the raft of policy reforms in the past 2 years including Shifting the Balance of Power and The Health and Social Care Act 2001 mean that the messages and even the language used in this booklet now look a little dated and perhaps oversimplistic. It describes the results of a survey sent to 481 primary care groups (PCGs) in 2000 to review the commissioning skills available to PCGs. After discussing the results from the 179 PCGs who returned the questionnaire, the booklet then details 11 standards for commissioning mental health services generated by an expert panel. In comparison with other similar work (Reference Wilkin, Gillam and ColemanWilkin et al, 2001) little methodological detail is given, which inevitably affects the validity and reliability of the conclusions. Primary care trust (PCT) commissioners interested in responding to the complexities of mental health also need to understand its place within the broader health and clinical governance context (Reference Rogers, Campbell and GaskRogers et al, 2002), which Setting the Standard, based on a survey 9 months after PCGs were officially created, is unable to provide. The result is a snapshot of a particular point in time, of historical interest perhaps, but not a living tool that many PCTs would now find helpful in guiding them through the commissioning maze.
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