20 - Primary care and management of long-term conditions

Summary

General practitioners spend at least a third of their time on mental health issues, although in all consultations the GP needs to be aware of possible psychosocial factors. Ninety per cent of all people with mental health problems are treated in primary care by the GP and the primary care team. Primary care offers accessible care close to the patient's home and with minimal stigma. Historically, general practice has offered personal care and longitudinal continuity, but care is becoming increasingly fragmented, with the necessity for IT systems to be the means by which continuity is achieved. General practitioners espouse the concept of holistic care, which is contextualised to the patient's background and culture.

Each GP consultation lasts about 10 minutes and GPs are faced with a random presentation of patients in each surgery. General practitioners work to a contract in which the Quality and Outcomes Framework (Department of Health, 2004) is now a major determinant of how care is delivered. For over 40 years, GPs have been accused of failing to diagnose depression (Goldberg ' Huxley, 1992; Kessler et al, 1999), and major educational initiatives both at undergraduate level and in GP training have endeavoured to reverse this.

Common mental health problems in primary care

The most common disorders presenting in primary care are depression and anxiety (see Chapter 3). Anxiety disorders include generalised anxiety disorder characterised by excessive anxiety and worry in all situations, a panic disorder characterised by unexpected and recurrent panic attacks or a phobia which may be specific or general. The term depression refers to a wide range of mental health symptoms, which are characterised by low mood and a loss of interest and enjoyment in ordinary things and experiences, together with a range of associated emotional, cognitive, physical and behavioural symptoms. It is not always easy to distinguish between mood changes in depression and those which occur normally.