- Functionalisation separates inpatient and community consultant roles, eroding individual patients' longitudinal clinical memory and fragmenting responsibility.
- At admission, discharge and aftercare, decisions are made without comprehensive patient history, concentrating risk where information is fragmented and responsibility unclear.
- Functional models fail to improve efficiency while damaging continuity; reform must be a proactive clinical priority rather than reactive to adverse events.
BJPsych Bull. 2026 Jul 20:1-3. doi: 10.1192/bjb.2026.10269. Online ahead of print.
ABSTRACT
Functionalisation – the separation of in-patient and community consultant roles – has eroded the longitudinal clinical memory of individual patients. Unlike specialisation, which deepens expertise, functionalisation has fragmented patient care. In functional models, critical decisions regarding admission, discharge and aftercare are often made without a comprehensive knowledge of the patient’s history. National inquiries highlight that risks cluster at these transition points, where information is fragmented and responsibility is unclear. Functional models fail to improve efficiency while significantly damaging continuity of care. Reform must become a proactive clinical priority rather than a reactive response to adverse events or inquiry findings.
PMID:42473432 | DOI:10.1192/bjb.2026.10269
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