Letters

Ann Richards and colleagues demonstrate clearly that they have failed to understand how primary care works.

Would any professional enter a specialty where mental health is so basic to care and not be interested? Yet that is the authors' conclusion.

Their arrogance is breathtaking: because their training programme has been spurned, the only possible explanation is that primary care is not interested - not perhaps that the training was inappropriate in design, methodology, character, location and timing.

Were the authors aware that over the past 30 years both the rate and duration of consultations have increased, hence the reasonable concerns about the training's workload implications? For a half-day training course, the GP must provide cover for their own absence and their practice nurse, which has financial consequences.

There are numerous examples of where primary care does take up training. In March all the practices in Oxford are closing for an afternoon so that GPs, nurses and clerical staff can attend a course on mental health in primary care. Cover has been arranged by the primary care group. This is not surprising, just a case of engaging primary care in an appropriate fashion.

The authors do not state that 90 per cent of patients with mental health problems are successfully managed in primary care without the intervention of secondary services, nor that up to 50 per cent of patients with a severe mental illness are managed by primary care alone.

Alan Cohen Head of primary care Sainsbury Centre for Mental Health Elaine Cohen Director of primary care Marylebone PCG