Vocational training: the end or the beginning?

performance and consultation skill work. The trial GPs improved their detection rate significantly, both compared to their performance at baseline and compared to the control group. Everyday consulting requires GPs to switch their attention quickly from perhaps an elderly arthritic patient, a patient with diabetes, a feverish child, and someone with headache, backache or persistent tiredness which may be caused by physical disease or be a sign of underlying psychological distress. Longer consultations would help, but it is probably just as important to make the best use of the time that is available and to organize the practice so that there is continuity of contact between the patient and a specific GP. It has been shown that the presence of a personal list system in practices is associated with increased patient satisfaction with accessibility, availability, continuity of care and medical care.'" Strategies are available to improve the ability of GPs to detect mental health problems and these can be supplemented by the judicious use of patient-completed questionnaires. Several different workers2"-22 have shown that detected disorders have a better outlook than those that remain undetected so helping GPs sharpen their recognition or management skills will directly benefit patient care.