In the early 1980s Strathdee and Williams described 'the silent growth of a new service', since 19 per cent of English psychiatrists were found to be carrying out various kinds of clinic in primary care. In the following year Pullen and Yellowlees (48) found that half of Scottish psychiatrists were offering similar clinics. Many of these clinics are little more than 'shifted outpatients' clinics where the location is nearer to the patient's home and is unstigmatized, so that attendance rates are better. At these clinics psychiatrists often encounter community nurses who are seeing other patients in the practice, but contact with GPs may be no better than with conventional outpatient clinics. Another problem is that few new patients are seen with this type of clinic—they are mainly those who have been on the psychiatrist's ward. Creed and Marks(49 described a consultation relationship in which the psychiatrist sees new patients with the GP, and advises the GP on the patient's future care. This has the advantage that both GP and patient may benefit from the psychiatrist's visit, yet the psychiatrist does not take over the patient's care.
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