Mental health policies and the focus of psychiatric services have shifted over the last three decades from hospital to community care. Greater care in the community and reduced psychiatric bed numbers have contributed to the discharge or non-admission of many patients with severe and persistent disorders who formerly would have been cared for in hospital. Increasing numbers of the chronically ill in the community will necessitate the development of systems to provide continuous and integrated services for such people.

Registers on people with learning disability are widely held (Cubbon & Malin, 1985). They have been set up in a variety of ways, hold differing types of data, and are put to various uses. Service planning and management is a common function for which register data may be required. However, a literature search revealed that no accuracy studies had been undertaken on such registers, apart from a reliability study on the Wessex Mental Handicap Register developed by Kushlick et al (May et al, 1982). In Wandsworth, an inner city health authority, the Register for People with Learning Difficulties is jointly funded and managed by the health authority and local social service department. The register holds data on just under 1,000 people who use services for people with learning disabilities, and the data are updated annually by questionnaires sent out by the register organiser. The questionnaire includes enquiry into demographic information, functional ability and service use. It also notes the presence or absence of additional complications, including psychiatric disorder and behaviours presenting specific management problems. This article describes a pilot study of the accuracy of the psychiatric and behaviour problem data held on the Wandsworth Register.

Letters from psychiatrists to general practitioners (GPs) should provide an appropriate content in a format which is easy to write and assimilate. For content, GPs have requested “key items” (diagnosis, suicide risk, treatment, prognosis and follow-up), and an explanation which is educational (Williams & Wallace, 1974; Pullen & Yellowlees, 1985; Margo, 1982). For format, GPs preferred a one page letter with two or three sub-headings in a survey based on one fictitious case (Yellowless & Pullen, 1984). Real letters from psychiatrists in one district averaged one and three quarter pages with four subheadings (Prasher et al, 1992). GPs' opinions about actual changes in the format and content of letters sent to them have not been reported.

Clinical research attempts to find out the best way to treat patients and audit attempts to make sure that patients are treated in the best possible way. The two are thus inextricably linked and should benefit from each other (Smith, 1992). In running a clinical research unit in which the personnel involved (two psychiatrists and two psychologists) have only honorary contracts, it is sometimes difficult to match the service offered to the clinical population required. A constant flow of patients does not mean a constant flow of those prepared or suitable to participate in research projects. Unlike clinical referrals, which are received passively, referrals of patients for research have to be looked for, even when treatment is on offer.

The Newcastle Mental Health NHS Trust Medical Audit Committee has become increasingly concerned with the problem of doctors within the Trust being unable to find sufficient time to devote to medical audit.

Many trainees contemplating becoming a consultant admit that their greatest concern is how they will find their way through the NHS bureaucracy and politics and relate to managers and colleagues who them selves are embroiled in these webs. We have therefore made management a high profile component of senior registrars' training during their 16-months placement in the Centre. As well as attending formal courses run by the King's Fund or the Region, trainees are exposed to diverse management issues and we ensure that the weekly hour of consultant supervision includes discussion of managerial and clinical matters.

When the idea was first proposed to our practice that we should have a doctor from the York Psychiatry Rotation attached to our practice as a trainee we were all enthusiastic. As the start date approached and it became more obvious that I, as the trainer without a trainee for the six months in question, would be responsible for him I became a little more apprehensive. What if he wore strange clothes? What if he upset all the patients? What if he exposed all my ignorance on matters psychological? When I first spoke to Simon he mentioned that he had not done any acute proper medicine since house jobs, five years previously; I do not know who was more apprehensive – him or me. In the event, of course, I feel the placement was successful and I hope that Simon came away learning a lot about general practice and a significant amount of psychiatry in a different setting.

A recent report by the Royal College of Psychiatrists (1993) on community supervision orders refers to the use of extended leave in Scotland. The legal basis for this practice is uncertain, and some explanation is required.

In 1961 Shaw & Macmillan claimed that there was no doubt of the value of the day hospital as an “alternative to in-patient care and prophylaxis” for the elderly mentally ill (EMI). Thirty years later the day hospital remains central to many EMI services. During these years little has been done to evaluate this method of service delivery against other models of service provision.