BLAND Division of General Practice and Primary Care St George ' s Hospital Medical School

Sir, Harvey et al (March Journal) undertook a randomized controlled trial and health economic evaluation of counselling in primary care. They found no difference in functional or mental health outcome at four months between subjects referred to counselling or those given usual care by their GP. They also found no clear difference in the cost effectiveness of the two interventions.' However, the emphasis given by the authors on functional and mental health outcomes may hide some of the other benefits of counselling identified within the study. Table 6 of the paper identifies that patients in the counselling group made substantially lower demands on GP time, were prescribed fewer drugs, and were less likely to be referred to specialist mental health services. These are benefits in themselves, but are not highlighted in the conclusions of the report. They are also outcomes that are directly sought from counselling.2'3 This trial shows that it is possible to achieve these benefits, which are improvements in the quality of care, through counselling, while maintaining the same outcome as traditional care and within a broadly similar cost envelope. In conclusion, it appears that this trial should be seen as being broadly supportive to counselling, given that it offers quality improvements with no effect on outcomes and no significant evidence of increase in costs.