Identifying patients at risk of psychosis: a qualitative study of GP views in South West England

BACKGROUND: Early intervention in people with an at-risk mental state for psychosis can decrease the rates of transition to psychosis. GPs play a key role in the identification of this patient group but very few studies have explored GPs’ awareness of patients who are at risk of psychosis. AIM: To explore GPs’ views and experiences of identifying patients with an at-risk mental state for psychosis, and the barriers and facilitators to identification. DESIGN AND SETTING: In-depth semi-structured interviews were held with GPs working in South West England primary care. The interviews were conducted between March and July 2019. METHOD: A topic guide was used to ensure consistency across interviews. This guide was revised to incorporate a definition of the at-risk mental state for psychosis, as after conducting a few interviews it became clear that some GPs were not familiar with this construct. Interviews were audiorecorded and analysed thematically. RESULTS: A total of 20 GPs were interviewed. Some GPs were not familiar with the concept of being at risk of developing psychosis, and perceived that they may not have the right skills to identify this patient group. Other barriers related to patients not presenting or disclosing psychotic symptoms, and limitations imposed by scarce resources on the structure and provision of NHS services, such as lack of continuity of care and high thresholds for accessing specialised services. CONCLUSION: Identifying people at risk of psychosis in primary care is difficult. Provision of GP training, development of policies that support continuity of care, and improved access to specialised services could help improve the identification of this patient group.