{"paper_id":"65085396-5314-414b-b3df-648a0f7bf414","body_text":"British Journal of General Practice, April 2015  175\nin the community, third-sector and statutory \norganisations, can all contribute.\nFor general practice and primary care \nthis will certainly require different training \nand more resources. The experience for all \ncould be quite different: an individual with \n‘stress’ booking straight into their choice \nof groups run by Improving Access to \nPsychological Therapies (IAPT) services; a \npatient with psychosis booking their follow \nup with the practice-based community \npsychiatric nurse through GP receptionists; \na third-sector practitioner liaising with \na GP to discuss the mutually accessible \nonline shared plan for an individual with \npsychosis; a GP calling a psychiatrist to \ndiscuss reducing doses of antipsychotic \nmedication for a patient the psychiatrist \nhad seen as a one off at the practice; the \npractice-based IAPT practitioner providing \ncognitive behavioural therapy for anxiety \nas part of the aftercare plan following \ncommunity-based alcohol detoxification. \nAll possible with a small shift in allocation \nof NHS resources.\nRichard Byng, \nProfessor in Primary Care Research \nand GP with a Special Interest in Mental \nHealth, Plymouth University, Plymouth.  \nE-mail: richard.byng@plymouth.ac.uk \nRefeRences\n1.  Green B, Gowans WJ. Mental health care in \nhospitals and primary care: an unsustainable \nbalance. Br J Gen Pract  2015; DOI: 10.3399/\nbjgp15X683365.\n2.  The Mental Health Policy Group. A manifesto for \nmental health . 2015. http://www.mentalhealth.org.\nuk/content/assets/PDF/publications/manifesto-\nbetter-mental-health.pdf (accsessed 4 Mar 2015).\n3.  Knapp M, Andrew A, McDaid D, et al.  Investing in \nrecovery: making the business case for effective \ninterventions for people with schizophrenia and \npsychosis . Rethink Mental Illness. 2014. http://www.\nrethink.org/media/1030280/investing_in_recovery.\npdf (accsessed 4 Mar 2015).\n4.  Murphy S, Irving CB, Adams CE, Driver R. Crisis \nintervention for people with severe mental illnesses. \nCochrane Database Syst Rev  2012; 5: CD001087.\n5.  Stanton E, Baggaley M. Are mental health patients \ngetting the right treatment? Results from a \ncomprehensive review of patient notes. 2012. http://\nbeaconhs.co.uk/wp-content/uploads/2015/02/\nbeacon-uk-assessing-mental-healthcare.pdf \n(accsessed 4 Mar 2015).\nDOI: 10.3399/bjgp15X684325\nD igital mental health \nservices in general \npractice\nClaire Harding and colleagues have \nhighlighted the potential of digital \ninterventions in general practice and the \nneed for NHS accredited or ‘kitemarked’ \napps, but also raise questions about the \nneed for evidence of their safety and \nefficacy.\n1\nThey state that ‘ ... there is broad \nconsensus in the field that traditional \nrandomised controlled trials are not fit for \npurpose with digital interventions (largely \nbecause services develop and expectations \nchange faster than trials can be run) ...’ . We \nacknowledge that good interventions take \ntime to develop and test, but do not agree \nthat this is a reason to abandon evidence-\nbased practice. Users and commissioners \nshould expect robust evidence before \nchoosing to invest time or resources in \nsuch interventions. \nFor simple health information on the \nweb, common sense ‘kitemarking’ may \nbe sufficient. However, for interventions \naimed at behaviour change, randomised \ncontrolled trials are warranted, regardless \nof whether they are delivered digitally. \nRapid changes in services are not sufficient \nreason to negate this necessity, as well-\ndeveloped interventions can be adapted to \nnew delivery systems.\n \nMiriam Santer, \nClinical Lecturer, University of \nSouthampton, Southampton.  \nE-mail: m.santer@soton.ac.uk \nHazel Everitt,\nClinical Lecturer, University of \nSouthampton, Southampton.  \nRefeRence\n1.  Harding C, Ilves P, Wilson S. Digital mental health \nservices in general practices. Br J Gen Pract  2015; \nDOI: 10.3399/bjgp15X683377. \nDOI: 10.3399/bjgp15X684337\nendometriosis in \nsecondary care\nAs a hospital gynaecologist I may not be the \nbest person to comment on your article 1  \nbut these are my thoughts. Symptoms \nthat could be due to endometriosis are \nextremely common in both primary care \nand the hospital gynaecology clinic. With \nthe exception of women who are currently \ntrying to conceive, it is perfectly reasonable \nto treat these symptoms hormonally. The \nearlier Royal College of Obstetricians and \nGynaecologists guideline as well as the \nmore recent European guideline you quote, \nboth recommend treating symptoms with \neither the combined contraceptive pill, an \novulation suppressing progesterone-only \npill, or the Mirena\n®  interauterine system. \nWomen referred to hospital because of the \nsupposed importance of early diagnosis may \nbe disappointed to be offered precisely those \ntreatments if they attend a consultant clinic.\n \nStewart Pringle, \nConsultant Gynaecologist, South Glasgow \nUniversity Hospitals, Glasgow.  \nE-mail: stewartpringle@netscape.net \nRefeRence\n1.  Johnston JL, Reid H, Hunter D. Diagnosing \nendometriosis in primary care: clinical update. Br \nJ Gen Pract  2015; DOI: 10.3399/bjgp15X683665.\nDOI: 10.3399/bjgp15X684349","source_license":"CC0","license_restricted":false}