Consultations in Primary Care

Established: April 2006; first meeting Sept 06, second meeting Sept 07

Convenor (Chair): Dr Hugh Middleton, Associate Professor, University of Nottingham. (e-mail: Hugh.middleton@nottingham.ac.uk)

Members: This represents a cross-cutting research group. The core group will be researchers from universities, primary care research networks and practices, and service users and carers, with added value through consolidating existing research groups examining primary care consultations; self-help, antidepressants and social capital.

Marta Busewicz: Senior Lecturer in Primary Care and Population Sciences, University College, London; Richard Byng: Peninsula Primary Care Research Network; Peter Campion: Professor of Primary Care Medicine, University of Hull; John Cape: Head of Psychology, Camden and Islington Mental Health and Social Care Trust and Honorary Senior Lecturer, University College, London; Rachel Churchill: Lecturer in Psychiatric Epidemiology, Institute of Psychiatry, Kings College, London; Sue Collinson: Service User Consultant, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary College, London; Christopher Dowrick: Professor of Primary Care, University of Liverpool; Jane Dyas: Primary Care Lead, Trent Research Development Support Unit, University of Nottingham; Linda Gask: Professor of Primary Care Psychiatry, University of Manchester; Amanda Howe: Professor of Primary Care, University of East Anglia; Helen Lester: Professor of Primary Care, University of Manchester; Karina Lovell: Professor of Mental Health, University of Manchester; Hugh Middleton: Associate Professor, School of Sociology and Social Policy, University of Nottingham; Michael Moore: Senior Lecturer, Primary Care, University of Southampton; Richard Morriss: Professor of Psychiatry and Community Mental Health, University of Nottingham; Roderick Ørner: Visiting Professor of Clinical Psychology, University of Lincoln; Chris Salisbury: Professor of Primary Health Care, University of Bristol; Peter Salmon: Professor of Clinical Psychology, University of Liverpool; Ian Shaw: Professor of Health Policy, School of Sociology and Social Policy, University of Nottingham; Niroshan Siriwardena: Professor of Primary Care, University of Lincoln; John Skelton: Professor of Clinical Communication, University of Birmingham.

Remit and Aims:
There are 750,000 primary care consultations daily in the UK, of which one third relate to mental health problems. Initial consultation in primary care is the principal tool of engagement, recognition, assessment, and decision making. It sets the scene for further developments but it remains a blunt instrument. This is especially true in the case of so-called common mental health problems where complex interactions between practitioner and patient can result in unfortunate unforeseen consequences.

The group will examine the primary care consultation, focusing upon consultations with GPs, community and practice nurses, graduate workers and other practitioners over mental health problems, in particular sub-threshold conditions and adjustment reactions.

Content and context will be considered; health care policies and the social worlds of patient and practitioner exert powerful influences upon such consultations.

Research will include the initiation of productive talk about emotions, the perceived meaning of mental health diagnoses and its effect upon consulting behaviours, the influence of the power held by patients and practitioners upon treatment decisions, practitioners’ involvement of socially excluded patients in decision making, and practitioners with poor mental health skills.

Methods will include discourse analysis examining the consultation; in-depth analysis of interviews with patients and practitioners; descriptive studies of consulting and help-seeking behaviour; analysis of mental health consultations using validated tools, and development of new tools and other interventions to improve clinical communication.

The work of this research group will provide information for:
• practitioners
• patients
• educationalists
• developing interventions to improve practice and mental health outcomes.
• planning and implementing primary care treatment trials.

Current Status & Future Plans:
The extent and economic cost of psychological disability is now recognised as a DH policy priority. As this is addressed it will become apparent that initial and subsequent consultations with the GP play a central part in determining how individuals’ “patient journeys” are determined. Initial research ideas include investigation into:

• The nature and frequency of sub-threshold mental health problems presenting in primary care.

• The nature of practitioners’ beliefs about mental health problems.

• An RCT of reattribution training.