Effective Primary Care in Mental Health Services - Essay Example

Effective Primary Care in Mental Health Services Mental illness was found to be the leading cause of disability in the whole world. According to theWorld Health Organization (WHO), 20% of people each year experience a diagnosable mental illness. In turn, only 25% of these receive help and most of that help is provided by primary care (USA, National Institute of Mental Health 2002). Moreover, consultations from routine general practitioners (GP) show that a quarter of these concern mental health problems and around 90% of the care comes solely from primary care (Mental Health, NHS England, 2006). Primary care refers to services provided by patients' personal physicians, who are usually family practitioners, general internists or general pediatricians (Bodenheimer, 2006). In what obtains now, primary care is facing a confluence of factors that could spell disaster. Thomas Bodenheimer (2006) reports of patients becoming increasingly dissatisfied with their care with the difficulty of gaining timely access to a primary care physician. Moreover, many primary care physicians are unhappy with their jobs as they face a seemingly insurmountable task. A study done by Gottschalk and Flocke found that primary care physicians spend nearly one half of their workday on activities outside the examination room, predominantly on follow-up and documentation of care for patients not physically present (Gilchrist, 2005). Further, Doherty (2006) reports that the quality of primary care is found uneven; reimbursement is inadequate; and fewer and fewer U.S. medical students are choosing to enter the field. That there is decline in primary care is not surprising, according to Kowalczyk (2006), given that primary care doctors work a harried pace with unpredictable hours while earning some of the lowest salaries in medicine. In the United States, primary care doctors earned an average of about $160,000 in 2004, compared with $230,000 for obstetricians/gynecologists and $300,000 for dermatologists, according to a consulting company, the Medical Group Management Association (Kowalczyk, 2006). In the midst of primary care physicians dwindling, there is a lack of strong primary-care base for the health system with improved care and reduced health care costs. In effect, patients are having a harder time getting timely appointments with their personal physicians, therefore seek expensive emergency room services, adding to the cost (Bodenheimer, 2006). As early as two decades ago, medical literature rued this situation, pointing out the imbalance between oversupplied specialties and the primary care specialties which are undersupplied (Primary Care Physicians, 1989). From international findings, some of the barriers to provision of primary mental health care include access, culture, recognition and knowledge, time, training, cost, stigma and discrimination, knowledge of, and relationships with, local networks, community organisations, and specialist mental health services (Underlying concepts, 2006). Yet, many doctors blame a national shortage of primary care doctors on limited access (Kowalczyk, 2006). The reasons for the imbalance, however, seem to be more complex and varied among hospitals. Many internists, especially women, are cutting back their hours to spend more time with their families. At the same time, the aging population and the increasing complexity of medicine mean that each patient requires more time and services, reducing the number of patients some doctors can see. (Kowalczyk, 2006). To Bodenheimer (2006) however, primary care is dying due to three main factors: 1) Low reimbursement rates for primary care services, 2) The stressful work life of primary care physicians, and 3) The dwindling number of US medical graduates choosing careers in family medicine. Doctors have been warning of a shortage of primary care physicians since early in the decade, with a number of medical students deciding not to practice general internal medicine. Twenty percent chose general internal medicine last year, down from 55 percent in 1998, according to Dr. Thomas Bodenheimer of the University of California at San Francisco (Kowalczyk, 2006). For more specifics, there are reports that most primary care physicians at Boston's top-tier teaching hospitals are so busy that they have officially closed their practices to new patients. Callers to Massachusetts General Hospital's physician referral line are told that all, or almost all, of the hospital's 178 primary care physicians are not accepting more patients. All 42 internists at Boston Medical Center have had full lists since four months ago, and 108 of Brigham and Women's Hospital's 120 primary care doctors have closed their practices to new patients. (Kowalczyk, 2006). In December of last year, Health Secretary Patricia Hewitt was saying, "Primary care trusts should delay treatment to cut deficits." This was reported by Rebecca Coombes (2005) in the British Medical Journal. In other words, primary care trusts should tell hospitals to "go slow" and delay inpatient treatments for up to six months in a bid to cut financial deficits to zero before the end of the financial year, the health secretary has said. The NHS is said to be forecasting debts, aiming also to reduce deficit by the end of the year. Ms Hewitt said she seriously expected trusts to reduce deficits (Coombes, 2005). Last month, reports from BBC News (Hospitals told, 2006) said "Hospitals in the South East are being told to delay routine patient appointments for eight weeks, otherwise they will not be paid for them." According to the report, the minimum period is being enforced by primary care trusts because a drive to meet government waiting time targets was costing too much money. In Kent and West Sussex, the trust chief executives were told that routine patients should not be seen "too promptly" because if hospitals failed to reduce the level of routine referrals under eight weeks, the strategic health authority (SHA) would "support non-payment by the relevant Primary Care Trust." From all the foregoing, Bodenheimer's ideas on stopping the demise of primary care may be in order. He had suggested a form of educational campaign which required: 1) Reform in the payment system; 2) Improvements within primary care practices that encourage regular primary care physicians; 3) Coordinated effort between employers and insurers, health care providers and patients, public and private institutions, and government; and 4) A re-invigorated public policy on primary care. Way back, the prime minister had promised structural changes in empowering primary care (Prime Minister's speech, 2001). Mentioned were "more systems of collaboration" which was to witness the emergence of multi-funds and commissioning groups in recognition of GPs needing resources and support that came from working with others. Among many other planned changes, included in structural change is strategic use of GPs. GPs were to be supported by practice nurses and pharmacists, but increasingly the practice will become the place where diagnostic tests and minor operations are carried out (Prime Minister's speech, 2001). There would be standards in the National Service Frameworks to consider this. By making greater use of telephone consultations, developing the skills of practice staff, and changing the way clinic sessions are organised, all the first wave practices are now to offer their patients an appointment within 48 hours. (Prime Minister's speech, 2001). At a time where face-to-face consultations are declining, doctors find the need for office systems such as electronic prescribing, electronic health records and telephone call triage protocols that could help streamline the physician's role and increase the efficiency of information management and decision support (Gilchrist, 2005). The use of nurses trained to be full primary-care providers is also a novel idea (Blackman, 2004), not to mention nurse-doctor teamwork earlier emphasized (Prime minister's speech, 2001). In sum, an effective service network in primary care should be able to have the following: 1) An improved payment system from referrals; 2) Government subsidy of trainings for primary care physicians; 3) Coordinated effort between employers and insurers, health care providers and patients, public and private institutions, and government; 4) A re-invigorated public policy on primary care. 5) Collaboration between multi-funds and commissioning groups in recognition of GP's work; 6) Developing the skills of practice staff towards mandatory appointment with patients within 48 hours; 7) Use of office systems such as electronic prescribing, electronic health records and telephone call triage protocols; and 8) Use of nurses trained to be full primary-care providers. With such innovations, the service network for primary care may be re-invigorated and made viable to the public. References Blackman, A. Is There a Doctor in the House The Wall Street Journal. October 11, 2004. Retrieved December 10, 2006, from http://webreprints.djreprints.com/1092601143383.html Bodenheimer, T. Primary Care - Will It Survive The New England Journal of Medicine. Volume 355:861-864. Number 9. August 31, 2006. Retrieved December 9, 2006, from http://content.nejm.org/cgi/content/full/355/9/861 Coombes, R. Primary care trusts should delay treatment to cut deficits. News. British Medical Journal (BMJ) Publishing Group Ltd. London. December 17, 2005; 331(7530): 1426. Doherty, R. B. Primary care finally getting policymakers' attention. American College of Physicians (ACP) Observer. October 2006. Retrieved December 9, 2006, from http://www.acponline.org/journals/news/oct06/washington.htm Gilchrist, V. Physician Activities during Time Out of the Examination Room Medical News Today. December 7, 2005. Retrieved December 10, 2006, from http://www.medicalnewstoday.com/medicalnews.phpnewsid=34624 Hospitals told to delay treatment. Consultants are told to work to a minimum eight-week waiting time. BBC News. England. Last Updated: November 23, 2006. Retrieved December 10, 2006, from http://news.bbc.co.uk/1/hi/england/6176944.stm Kowalczyk, L. Hospital doctors shut doors to new patients. Many are forced to go to health centers. The Boston Globe. November 12, 2006. Retrieved December 9, 2006, from http://www.boston.com/business/healthcare/articles/2006/11/12/hospital_doctors_shut_doors_to_new_patients/ Mental health. National Health Service in England. Retrieved December 10, 2006, from http://www.nhs.uk/England/AboutTheNHS/Nsf/MentalHealth.cmsx Primary Care Physicians: Financing Their Graduate Medical Education in Ambulatory Settings (1989) Institute of Medicine (IOM). Retrieved December 9, 2006, from http://newton.nap.edu/books/0309041341/html/1.html Prime Minister's speech 'Empowering primary care and supporting GPs in the NHS.' March 19, 2001. Retrieved December 10, 2006, from http://www.number-10.gov.uk/output/Page1586.asp Underlying concepts. Development Guidelines for Primary Care. Development of Mental Health Service Retrieved December 9, 2006, from http://www.moh.govt.nz/moh.nsf/ Read More