Developing a local shared care protocol for managing people with psychotic illness in primary care

Abstract

Aims and method: The National Service Framework sets standards to improve the treatment of mental health on a national level, and requires the development of localised shared care protocols. We aimed to develop a shared care protocol for use in local National Health Service (NHS) services, based on best practice guidelines and local consensus. A systematic literature search used three databases and the advice of a clinical expert. Articles satisfying the search inclusion criteria were retrieved and appraised. Clinical recommendations from well-designed regional and national documents relevant to all aspects of the management of psychotic illness in primary care were compared and contrasted by a facilitated group involving primary and secondary care clinicians who drafted the final recommendations. A multi-agency steering group guided the work. Results: Twenty-two articles were retrieved, of which nine reached the criteria for inclusion.The protocol provided a comprehensive range of recommendations regarding detection, assessment, management, referral and shared working with local mental health services. Clinical implications: Using local clinical consensus to resolve uncertainty about conflicting clinical recommendations from a series of well-designed guidelines was an effective method for adapting clinical guidelines to local circumstances.