The results reported by Dr Tarrant (Psychiatric Bulletin, August 2006, 30, 286–288) on blood glucose testing for adults prescribed atypical antipsychotics are far more impressive than we obtained when we audited prescribing on acute psychiatric wards in four health districts in the West Midlands in 2004. Adherence to blood glucose testing ranged from 8 to 47% between these units for patients on atypical antipsychotics. These rates are poor even when allowing for an unwillingness of some patients with acute illness to agree to blood tests (Reference Hodgson and AdeyemoHodgson & Adeyemo, 2004).

In 2004 we carried out a survey of 181 consultant psychiatrists working across the West Midlands and found that only 52% undertook blood glucose monitoring and only 29.6% believed that psychiatrists should monitor the physical health of their patients. This survey underlined the tension between primary and secondary care over physical health monitoring for those with serious mental illness. The recent guidelines (National Institute for Health and Clinical Excellence, 2006) for the management of bipolar disorder recommend an annual physical health review in primary care. However, while a patient is in hospital it is difficult to justify any lack of monitoring of physical health given that psychiatry is a medical specialty. Abrogation of responsibility for physical evaluation of patients has implications for the profession as a whole. Acknowledgement of this responsibility is reflected in the College's requirement that candidates perform a physical examination in the both parts of the Membership examination. However, consultant psychiatrists are unlikely to maintain these skills, which is a compelling argument for basing the physical healthcare of those with serious mental illness in primary care.