Counselling: filling a gap in general practice

A counsellor worked for 1 year in three practices in a rural area where there was previously no practice-based counselling. The service was evaluated, using a range of methods, in order to inform general practitioners and policy-makers about the demand for counselling, where it fits with other services, its potential value and how to organise and audit the service efficiently. Five kinds of information were collected: administrative data; patients' views; well-being scores; GPs' perceptions of individual patients; and interviews with the counsellor, GPs and other primary care staff by an independent researcher. All the GPs used the service, referring 131 people. The most common reason for referral was 'relationship difficulties'. There were improvements in patients' well-being, self-awareness and coping skills, and high satisfaction among GPs and patients. Communication with other services was seen to improve. The counselling service was found to fill a gap by addressing the needs of a substantial group of patients for whom psychiatric care was inappropriate.