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Physical care of psychiatric patients to receive major boost

Over 300,000 people with serious mental illness to receive comprehensive physical health checks

Mark Gould

Thursday, 15 May 2014

Over 300,000 people with serious mental illness such as schizophrenia or bipolar disorder are to receive comprehensive physical health "MOTs".

NHS England has announced that mental health trusts all over the country will now receive financial rewards for carrying out the checks, including smoking status, diet, weight, blood pressure, glucose and fats or lipids, and ensuring identified illnesses are treated.

The move follows criticism of changes in December last year when GPs were no longer paid to provide physical health checks over 300,000 patients with serious mental health (SMI) conditions such as bipolar disorder, psychosis and schizophrenia.

Officials says the move represents the world’s largest ever initiative to improve the physical health of people with serious mental illness and is considered key to helping patients avoid early death due to conditions such as cardiovascular disease, lung disease and liver disease.

People with SMI have a high incidence of these physical illnesses as a result of their lifestyle and weight gain caused by anti-psychotic medication. These factors plus poor physical care mean that people with SMI can die up to 15 years earlier than the general population, which is the life expectancy of people living in the 1950s.

NHS England says people with SMI often do not access healthcare in the same way as the general population so introducing these checks and getting treatment started while they are admitted to hospital is deemed crucial.

Dr Geraldine Strathdee, NHS England’s National Clinical Director for Mental Health, said: “We are committed to making sure that mental health is treated the same way as physical health and NHS England is working hard to close the gap between the two with great support from partners and the field.

“The national financial incentive we have introduced this year for trusts is the world’s largest ever initiative in improving physical health in people with severe mental ill health conditions and will be a clinical quality game changer. It’s England’s first significant landmark in this area.

“We are starting by targeting in-patients who we know are most at risk, and where there are major opportunities to increase knowledge about healthy lifestyles and support smoking cessation. They are also in the best position to receive both assessments and treatment for those common conditions that are killing our patients 14 to 20 years early.”

The initiative also vitally incentivises and promotes excellent communication between the mental health service and the patients’ GPs and practice nurses who continue the physical health care post discharge. This collaboration is key to sustainability as care after discharge is as important as care on the ward.

Providers of mental health services will receive a financial incentive for meeting specific targets on undertaking physical health checks and delivering interventions. The incentive is being paid through the national CQUIN (commissioning for quality and innovation) scheme, set from April 1 2014. The professionals carrying out the checks will include mental health nurses, psychiatrists, health care assistants and psychologists.

The CQUIN will require them to provide interventions where a patient has poor physical health, and this could include referring the patient to another consultant or providing education and services such as weight management, stop smoking, diabetes or other relevant lifestyle programmes.

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