Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2002 Feb; 52(475): 101–107.
PMCID: PMC1314216

Relationship style between GPs and community mental health teams affects referral rates.


BACKGROUND: Community mental health teams (CMHTs) are the established model for supporting patients with serious mental illness in the community. However, up to 25% of those with psychotic disorders are managed solely by primary care teams. Effective management depends upon locally negotiated referral and shared care arrangements between CMHTs and primary care. AIM: To examine whether the style of working relationship between general practices and CMHTs affects the numbers and types of referrals from general practices to CMHTs, taking into account population and practice factors and provision of other mental health services which may influence referral rates. DESIGN OF STUDY: Cross-sectional study. SETTING: All 161 general practices in East London and the City Health Authority. METHOD: Questionnaire survey to all general practices to identify style of relationship. Collection of routinely available referral data to all statutory mental health services over a two-year period. Main outcome measures were number and types of referrals from general practices to CMHTs. RESULTS: The average annual referral rate to the eleven CMHTs in east London is 10 per 1000 adult population annually. The teams show a sixfold variation in rates of referral from all sources. Where good working relationships (a consultation-liaison style) exist between CMHTs and general practice, there are greater numbers of referrals requiring both long and short-term work by CMHTs. Two-stage multivariate models explained 47% of the referral variation between practices. Where primary care-based psychologists work with practices there are greater numbers of CMHT referrals, but less use of psychiatric services. CONCLUSION: Shifting to a consultation-liaison relationship should increase rates of referral of patients with serious mental illness, including those who can most benefit from the skills of CMHTs. Increasing the provision of primary care-based psychology might improve practice use of mental health services, reducing avoidable outpatient psychiatric referrals.

Full Text

The Full Text of this article is available as a PDF (80K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kendrick T, Sibbald B, Burns T, Freeling P. Role of general practitioners in care of long term mentally ill patients. BMJ. 1991 Mar 2;302(6775):508–510. [PMC free article] [PubMed]
  • Brown June S L, Weich Scott, Downes-Grainger Elin, Goldberg David. Attitudes of inner-city GPs to shared care for psychiatric patients in the community. Br J Gen Pract. 1999 Aug;49(445):643–644. [PMC free article]
  • Ford R, Durcan G, Warner L, Hardy P, Muijen M. One day survey by the Mental Health Act Commission of acute adult psychiatric inpatient wards in England and Wales. BMJ. 1998 Nov 7;317(7168):1279–1283. [PMC free article] [PubMed]
  • Kendrick T, Burns T, Freeling P, Sibbald B. Provision of care to general practice patients with disabling long-term mental illness: a survey in 16 practices. Br J Gen Pract. 1994 Jul;44(384):301–305. [PMC free article] [PubMed]
  • Jackman Bradley R. Equine Surgery. Can Vet J. 1994 May;35(5):305–305. [PMC free article]
  • Bindman J, Johnson S, Wright S, Szmukler G, Bebbington P, Kuipers E, Thornicroft G. Integration between primary and secondary services in the care of the severely mentally ill: patients' and general practitioners' views. Br J Psychiatry. 1997 Aug;171:169–174. [PubMed]
  • Gask L, Sibbald B, Creed F. Evaluating models of working at the interface between mental health services and primary care. Br J Psychiatry. 1997 Jan;170:6–11. [PubMed]
  • Mayou RA. Psychiatry, medicine and consultation-liaison. Br J Psychiatry. 1997 Sep;171:203–204. [PubMed]
  • Naish J, Sturdy P, Toon P. Appropriate prescribing in asthma and its related cost in east London. BMJ. 1995 Jan 14;310(6972):97–100. [PMC free article] [PubMed]
  • Nicoll A, Bassett K, Ulijaszek SJ. What's in a name? Accuracy of using surnames and forenames in ascribing Asian ethnic identity in English populations. J Epidemiol Community Health. 1986 Dec;40(4):364–368. [PMC free article] [PubMed]
  • Majeed FA, Cook DG, Anderson HR, Hilton S, Bunn S, Stones C. Using patient and general practice characteristics to explain variations in cervical smear uptake rates. BMJ. 1994 May 14;308(6939):1272–1276. [PMC free article] [PubMed]
  • Hull S, Harvey C, Sturdy P, Carter Y, Naish J, Pereira F, Ball C, Parsons L. Do practice-based preventive child health services affect the use of hospitals? A cross-sectional study of hospital use by children in east London. Br J Gen Pract. 2000 Jan;50(450):31–36. [PMC free article] [PubMed]
  • Melzer D, Watters L, Paykel E, Singh K, Gormley N. Factors explaining the use of psychiatric services by general practices. Br J Gen Pract. 1999 Nov;49(448):887–891. [PMC free article] [PubMed]
  • Roland MO, Bartholomew J, Morrell DC, McDermott A, Paul E. Understanding hospital referral rates: a user's guide. BMJ. 1990 Jul 14;301(6743):98–102. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...