Learning from the difference in practice between general Practitioners and Mental Health Practitioners in Primary Care

Peter McNelly is a seasoned Mental Health Nurse, with over 50 years’ experience, and in the last 5 years has worked in 8 different GP Practices, in Northern Ireland and England.

As a Mental Health Practitioner (MHP), I have worked in eight different GP practices across Northern Ireland and England. Within these settings, I have collaborated with at least thirty GPs with a wide range of experience — several with over twenty-five years in general practice.

I am a mental health nurse working within a Primary Care Network (PCN) GP practice and have spent over fifty years working across various mental health services. ¹ Based on this experience, I believe that when a patient presents with a mental health concern, a consultation with a MHP — even one who is not a prescriber — is often more appropriate and effective than one with a GP.

Why is this the case?

Several key factors can make consultations with an MHP preferable for patients presenting with mental health issues.

1. Time
I am allocated 30 minutes for my consultations, while GPs typically have 10 minutes. However, GPs sometimes book double slots if they are aware of mental health concerns prior to the appointment. ²
The extended time allows MHPs to explore issues more thoroughly and build rapport, both of which are essential in mental health care.

2. Training
My professional training as a Mental Health Nurse focused entirely on mental health — encompassing psychological, social, and emotional aspects of wellbeing, rather than being confined to the medical model.
By contrast, GP training is primarily focused on physical health. ³ This difference in emphasis naturally shapes how each practitioner approaches a consultation.

3. Experience
In addition to formal training, I have accumulated decades of practical experience across diverse mental health services, continuously developing my knowledge and skills.
GPs receive relatively little structured training in mental health⁴⁵ yet see the majority of patients presenting with such concerns — more than any other professional group within general practice, including MHPs.
While GPs build experience with each passing year, this does not necessarily translate into deeper understanding or improved attitudes toward mental health. Often, a lack of knowledge about the nature, outcomes, and relapsing patterns of mental health conditions limits the value of that experience. ⁶⁷

4. Assessment
My assessments are comprehensive and typically include:
• Social background and context
• Substance use
• Suicidal ideation or self-harm risk
• Past mental health history
• Employment and life stressors
• Coexisting physical health conditions

This psychosocial approach enables supportive ventilation (“A problem shared is a problem halved”) and ensures that patients have an active role in deciding the most appropriate next steps — such as watchful waiting, medication with review, counselling/therapy, or, where necessary, referral to secondary care. My assessment tools are self and box of tissues.

In contrast, GPs rarely conduct such detailed assessments.⁸ in my experience, and for the reasons outlined above (time, training, experience), GP assessments are often less comprehensive.

GPs are, by definition, generalists. It is therefore unrealistic to expect their scope of practice to match that of a Mental Health Practitioner. However, creating more opportunities for GPs to engage in collaborative discussions with MHPs could foster valuable knowledge sharing.⁹ Over time, this may enhance GPs’ confidence and competence when managing patients with mental health concerns — ultimately benefiting patients across primary care.

References

1. McNelly, P. (2021). Reflections on Multi-disciplinary Team Working in General Practice in Northern Ireland. BJGP Life, 17 November 2021. https://bjgplife.com/reflections-on-multi-disciplinary-teams-working-in-and-alongside-general-practitioners-in-northern-ireland/ [accessed 19/10/2025]
2. BMA (2025). Safe Working in General Practice in England: Guidance. 16 September 2025. https://www.bma.org.uk/advice-and-support/gp-practices/managing-workload/safe-working-in-general-practice  [accessed 19/10/2025]
3. Papachristopoulos, I., Sazakli, E. & Leotsinidis, M. General practitioners’ views towards management of common mental health disorders: Τhe critical role of continuing medical education. BMC Prim. Care 24, 63 (2023). https://doi.org/10.1186/s12875-023-02017-5
4. Mind (n.d.). Better Equipped, Better Care: Improving Mental Health Training for GPs and Practice Nurses.
5. Royal College of General Practitioners (2017). Mental Health in Primary Care. https://www.rcgp.org.uk/representing-you/policy-areas/mental-health-in-primary-care [accessed 19/10/2025]
6. Bhabdari, S. (2025). Depression Relapse: What to Do First. WebMD, 11 July 2025. https://www.webmd.com/depression/depression-relapse [accessed 19/10/2025]
7. Ali S, Rhodes L, Moreea O, McMillan D, Gilbody S, Leach C, Lucock M, Lutz W, Delgadillo J. How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study. Behav Res Ther. 2017 Jul;94:1-8. doi: 10.1016/j.brat.2017.04.006. Epub 2017 Apr 18. PMID: 28437680.
8. Two-Thirds of GPs Providing Specialist Mental Health Support Beyond Their Competence. Pulse Journal, 9 May 2022.
9. Pattni, S. (2024). Being a Slow GP Isn’t All Bad. Pulse Journal, 2 July 2024.

Featured photo by Cherry Laithang on Unsplash