you & your care improving the quality of physical health checks kate dale mental/physical...

You & Your Carewww.bdct.nhs.uk

Improving the Quality of Physical Health Checks

• Kate Dale

Mental/Physical Health Project Lead Bradford District Care Foundation

Trust (BDCFT)


Research• The most notable is a shorter lifespan, reduced

by around 20 years compared to the general population

• There is considerable evidence that one of the main causes of early death in people with Severe Mental Illness (SMI) is cardiovascular disease

• Other physical causes include cancer• Patients with SMI experience health

inequalities


The Quality and Outcomes Framework (QOF)What is QOF?The quality and outcomes framework (QOF) introduced on 1 April 2004, is part of the General Medical Services contract for general practices. The QOF rewards practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care.

A physical health check within the last 12 monthsUntil recently did not specify what the health check should include.

Recommends:Recording Alcohol consumptionBody Mass Index (BMI)Blood Pressure (BP)Cholesterol/HDLBlood GlucoseCytology Recordings

However it does not specify interventions


Present QOF

• Blood Pressure• Alcohol• Cervical Screening• Lithium


Case study from SMI physical health check

• Male age 60• Severe Chronic obstructive pulmonary

disease (COPD)• BMI 15• Severe peripheral vascular disease• Auditory hallucinations severe anxiety


Mental/Physical HealthQoF Indicators

Physical health to be reviewed at 12 monthly intervals.

The review includes a check on accuracy of any prescribed medication Side effect monitoring Review of physical health Review of co-ordination arrangements with secondary careLithium monitoringThe practice has a (SMI) register


National Institute for Clinical Excellence (NICE)

• Offers guidance for: • Bipolar disorder (CG38)• Schizophrenia (CG82)


Proposal to address health inequalities in the SMI population in Bradford

• A more specific standardised data entry template based on existing mental health QOF indicator

• Specific to areas of physical health risks prevalent to those with SMI

• More specific tests e.g. blood tests for diabetes, cholesterol, ECG and other appropriate tests.

• Auditable across the whole city using the SystmOne primary care information system


Audit Outcome• 12 practices audited• Using QOF SMI registers• 20% of each register• Random sample• Total of 104 patients included• Anonymous• 42% female 58% male


Audit Findings• No patients had been given a

cardiovascular risk calculation• This would be a good way to identify high

risk people for prevention• No patients had a blood test for prolactin

levels (elevated prolactin is a significant and common adverse effect of antipsychotic treatment)


The SystmOne Physical Health Check Template

What does it look like?


RIO Version RiO is an electronic patient record system, used to support Mental Health & Learning Disabilities services.

Now Live in Secondary Care

New Physical Health/Wellbeing Clinics in 5 Community Mental Health Teams across Bradford District Care Foundation Trust


Month Location

Number of patients seen in clinic

Number of

DNAs

Depot Patients New Initiation

Patients

High Dose

Antipsychotic

Patients

General

Patients

January South & West 8 7 12 3 8

February South & West 2 - 1 21 6

January City 16 3 - - -

February City 40 3 - 2 -

January North 12 3 - 1 0

February North 8 6 3 3 3

January Meridian 14 - - 2 6

February Meridian 8 7 9 3 10

January Craven 2 - - - -

February Craven 8 7 5 3 9


Month Location

Number of patients seen in clinic

Number of DNAsReferrals New Initiation Patients

April South & West 64 5 15

April City 49 4 10

April North 22 12 0

April Airewharfe and Craven 44 8 13

April Craven 8 0 0


Experience

• 13 years!• Relationships• Education• Support• Standardised approach• Meaningful


Barriers• Fear• Workload• Technology (Morrison's & Sainsbury’s)• Knowledge• Expectations (Going the extra mile)• Support• Time


Learning• People• Resistance• Core groups• Avoid working on own (standardisation)• Losing Confidence• Focus• Communication


Where we are now• Rolled out to ALL GP practices.• Replicated on different IT systems• Opened 5 clinics in secondary care• Rolled out in ALL in patient areas• Communicated to GP electronically for

inpatient discharges


Where we are now cont…..

• Rolled out physical health training to all band 2,3,4 (Calderdale)

• Recognising and Assessing Medical Problems in Psychiatric Settings (RAMPPS)

• Link workers• Standardised Simple Kits on all areas• Electrocardiogram (ECG)• Smoke Free


Recognition Local & National• Endorsed by Geraldine Strathdee (National

Director for Mental Health NHS England)

• Adopted across various sites in England• Academic Health Science Networks

(Yorkshire and Humber) supporting roll-out regionally

• Supported by NHS Improving Quality • NHS Education England


Interested Organisations So Far!• Greater Manchester West Mental Health

NHS Foundation Trust, • NHS Hardwick CCG• South East Leeds Community

Mental Health Services• Oxford Health NHS Foundation Trust• Older People’s & Urgent Care Services

Oxfordshire


Interested Organisations

• South Central and West Commissioning Support Castlewood

• NHS Southern Derbyshire Clinical Commissioning Group

• Midlands and Lancashire CSU


Thank you very much for listening

For more information, contact:

Kate Dale

Mental/Physical Health Project Lead

Email: [email protected]

Angela Moulson

Clinical Specialist Lead Adult Mental Health and LD Bradford and Lead GP

Email: [email protected]

mailto:[email protected]

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