Mental health care professionals and general practice

psychological distress' suggests that it is in such subgroups of the population that GPs can improve their performance. Work in our own practice also supports the feasibility of the Geriatric Depression Scale for use by practice nurses in screening assessment. However, the use of mental health-screening questionnaires in primary care remains uncommon.2 If there is pressing evidence of underperformance, therapies available, and effective trainings"13 and instruments that exist which can improve detection, we must consider why primary care teams fail to avail themselves of these options. Several possibilities exist: the evidence has failed to reach them, the resources required (such as time with patients, time for training, drug budgets) are lacking, or there is attitudinal resistance from either staff or patients. I would support the editorial's emphasis on the need to focus both research and training on the practice team, and new educational initiatives which encourage more active participation in planning our continuing professional development4 may be helpful here. However, in recent education meetings within our own practice, we have had evidence of 'cultural clashes', in that many staff perceive increased medication (whether for depression or lipid-lowering!) as a further medicalization of a society which is becoming unacceptable. Some of these attitudes are echoed by the patients, who may prefer the 'listening ear'; indeed, some of the undertreatment mentioned earlier is known to relate to non-acceptance by patients. Those of us who engage with practice-based education will therefore need to accept a considerable level of 'critical dialogue'5 with our peers, concerning not only specific trainings and treatments, but also the whole concept of evidence-based medicine, resource allocation, and the different professional attitudes of doctors, nurses, and practice counsellors. I would hope that the RCGP would support more evaluative research into the realities of practice-based education.