Primary and secondary care for mental illness: Impact of a link worker service on admission rates and costs

A previous study showed that basing community mental health (CMH) services in primary care resulted in greatly increased rates for treated illness, but no cost offsets to compensate for this by reductions in admission rates. Method: The present study prospectively compares services in Peckham - with link workers from the CMH team, each caring for all those with SMI (severe mental illness) cared for by particular GPs - with Brixton services, organised on traditional lines. Results: There was no consistent change in the characteristics of patients seen by the two services, and a focus on SMI was maintained. Admission rates and costs varied widely over the study period, but variations were not associated with the intervention. Conclusion: The structural obstacles to joint working between primary and secondary care can be addressed by basing sector services on GP practices, without diverting staff to the care of other patients. Costs fluctuated, and there was no evidence of a compensating cost offset to pay for the increased costs of the new service.