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Getting a balance between generalisation and specialisation in mental health services: a defence of general services

  • Richard Laugharne (a1) (a2), Matthew Thompson (a2), Alind Srivastava (a2), Simon Marlow (a2) and Rohit Shankar (a1) (a2)...

Abstract

Mental health services in the UK National Health Service have evolved to include primary-care generalist, secondary-care generalist and secondary-care specialist services. We argue that there continues to be an important role for the secondary-care generalists as they minimise interfaces, can live with diagnostic uncertainty and support continuity of care. The lack of commissioning and clinical boundaries in secondary-care generalist services can undermine their feasibility, leading to difficulties recruiting and retaining staff. There is a risk of a polo-mint service, where the specialist services on the edge are well resourced, but the secondary-care generalist services taking the greatest burden struggle to recruit and retain clinicians. We need to establish equity in resources and expectations between generalist and specialist mental health services.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to Dr Richard Laugharne (richard.laugharne@nhs.net)

References

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Getting a balance between generalisation and specialisation in mental health services: a defence of general services

  • Richard Laugharne (a1) (a2), Matthew Thompson (a2), Alind Srivastava (a2), Simon Marlow (a2) and Rohit Shankar (a1) (a2)...
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eLetters

Another option to get the balance right between specialist services and generalist services.

Rollo Sheldon, ST7 Neuropsychiatry, South West London and St George's Mental Health NHS Trust
28 December 2018

I read your editorial with great interest as it struck a personal chord, and hope it will be widely read by commissioners. As a trainee, I have experienced a variety of generalist and specialist services. For example, I am currently in a super-specialist service (neuropsychiatry), having come from a generic old age psychiatry post, but I find them both very enjoyable.

A fourth option therefore that I propose, to get the balance right between specialists and generalists not suggested in your editorial, is that all staff could work in both specialist and generalist services. That way, they will develop skills pertinent to both, and enjoy variety in patients, teams, and careers. ... More

Conflict of interest: None declared

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