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

Abstract

<jats:p>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.</jats:p><jats:sec id="S2056469418000529_sec_a1"><jats:title>Declaration of interest</jats:title><jats:p>None.</jats:p></jats:sec>