A tale of two systems: perceptions of primary care for depression in London and Melbourne

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Abstract
Background. Depression represents a major and growing disease burden. About 90% of depressed patients are treated solely in primary care, yet there are system-related barriers to primary care for people with depression in the UK and Australia, countries which have different health care arrangements. Objectives. The aim was to explore the views of GPs and patients in London and Melbourne about primary care system features which support or hinder best care for mild-to-moderate depression. The study differentiated between policy and reality ‘on the ground’. Methods. Two round Delphi technique methodology with four panels: GPs and patients in London and GPs and patients in Melbourne, to elicit views on the extent to which system features were reflected in policy, reflected in reality and were of value for best care. Results. Four themes were generated: system and financing, responsibility and continuity, consultations and primary care team. Patient-centred care, having sufficient time during a consultation, and the GP–patient relationship extending over time were rated highly by all panels. Panellists differentiated between policy and reality on a number of features. Conclusions. The Australian system does not guarantee continuity of care with practitioner or practice but patients took steps to see the same doctor for depression. There was a difference in the way London and Melbourne panels responded to finance-related statements. There was a tendency for panellists to value aspects of their own system and to fail to see possibilities of other systems.