Table 4 Views regarding a specialist nurse model for providing CHD screening in SMI

Perceived advantages

• There would be greater accessibility to screening for patients

• It would introduce more flexibility into a system which otherwise only suits certain patient profiles

• The nurse would provide specialist cross-disciplinary knowledge in a complex area that few CMHT staff or GPs feel wholly confident in.

• This model has worked successfully in other areas e.g. offering HIV testing in a drug dependency unit; a hepatitis nurse attached to a community drug team

• A nurse could bridge the existing gaps between primary and secondary care

• It would prevent the burden falling on already overworked CMHT workers and allow them to concentrate on their "traditional [mental health] work".

• Mobile services are also successful e.g. breast screening, needle exchanges

• It would facilitate communication, allow monitoring of the service and improve liaison between different parts of the service.

• It would allow a trusting ongoing clinical relationship to be established with the specialist nurse who knows about physical health issues

• The nurse could take on additional roles e.g. running interventions, groups, prescribing

• Someone needs to take specific responsibility to ensure that screening does happen

• One specialist nurse could be employed across whole Primary Care Trusts

Perceived disadvantages

• There might be too much or (in the view of a different participant) too little work for the specialist nurse to provide

• It would be an expensive option and thus is unlikely to be prioritised or commissioned – non-attendance rates may be too high to justify the cost

• It adds another person into the health service equation and complicates it

• It might encourage further dependence on the service by people with SMI, rather than them accessing their GP like everybody else

• It may make patients link physical side effects to their antipsychotic medication, encouraging cessation of treatment

• It may create suspicion when SMI patients feel "singled out" for a special service