Sir: The primary care psychiatric screening clinic described by Hamilton et al (Psychiatric Bulletin, June 2002, 26, 218-221) is an excellent idea. Joint interviewing is an invaluable tool in psychiatric practice.
However, in 1980 I took over from a consultant who had looked after a catchment population of 100 000 with one community psychiatric nurse, one social worker and no junior medical staff. He saw 80 out-patients each week: 10 minutes for new referrals and 5 minutes for returns. Medical records consisted of the date and a single abbreviation for the diagnosis. Clinic letters were three sentences or fewer.
My predecessor's diagnoses were usually proved right. General practitioners missed his rapid response to referrals and his brevity. Screening has its value but in the new world of primary care trusts it will be important that psychiatrists speak out for a full range of services for the mentally ill.
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