1. You & Your Care www.bdct.nhs.uk Improving the Quality of Physical Health Checks Kate Dale Mental/Physical Health Project Lead Bradford District Care Foundation Trust (BDCFT)

2. You & Your Care www.bdct.nhs.uk 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

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4. You & Your Care www.bdct.nhs.uk 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 months Until recently did not specify what the health check should include. Recommends: Recording Alcohol consumption Body Mass Index (BMI) Blood Pressure (BP) Cholesterol/HDL Blood Glucose Cytology Recordings However it does not specify interventions

5. You & Your Care www.bdct.nhs.uk Present QOF Blood Pressure Alcohol Cervical Screening Lithium

6. You & Your Care www.bdct.nhs.uk 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

7. You & Your Care www.bdct.nhs.uk Mental/Physical Health QoF 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 care Lithium monitoring The practice has a (SMI) register

8. You & Your Care www.bdct.nhs.uk National Institute for Clinical Excellence (NICE) Offers guidance for: Bipolar disorder (CG38) Schizophrenia (CG82)

9. You & Your Care www.bdct.nhs.uk 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

10. You & Your Care www.bdct.nhs.uk 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

11. You & Your Care www.bdct.nhs.uk 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)

12. You & Your Care www.bdct.nhs.uk The SystmOne Physical Health Check Template What does it look like?

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15. You & Your Care www.bdct.nhs.uk 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

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17. You & Your Care www.bdct.nhs.uk MonthLocation Number of patients seen in clinic Number of DNAs Depot Patients New Initiation Patients High Dose Antipsychotic Patients General Patients JanuarySouth & West871238 FebruarySouth & West2-1216 JanuaryCity163--- FebruaryCity403-2- JanuaryNorth123-10 FebruaryNorth86333 JanuaryMeridian14--26 FebruaryMeridian879310 JanuaryCraven2---- FebruaryCraven87539

18. You & Your Care www.bdct.nhs.uk MonthLocation Number of patients seen in clinic Number of DNAs Referrals New Initiation Patients AprilSouth & West64515 AprilCity49410 AprilNorth22120 April Airewharfe and Craven 44 813 April Craven80 0

19. You & Your Care www.bdct.nhs.uk Experience 13 years! Relationships Education Support Standardised approach Meaningful

20. You & Your Care www.bdct.nhs.uk Barriers Fear Workload Technology (Morrison's & Sainsbury’s) Knowledge Expectations (Going the extra mile) Support Time

21. You & Your Care www.bdct.nhs.uk Learning People Resistance Core groups Avoid working on own (standardisation) Losing Confidence Focus Communication

22. You & Your Care www.bdct.nhs.uk 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

23. You & Your Care www.bdct.nhs.uk 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

24. You & Your Care www.bdct.nhs.uk 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

25. You & Your Care www.bdct.nhs.uk 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

26. You & Your Care www.bdct.nhs.uk Interested Organisations South Central and West Commissioning Support Castlewood NHS Southern Derbyshire Clinical Commissioning Group Midlands and Lancashire CSU

27. You & Your Care www.bdct.nhs.uk Thank you very much for listening For more information, contact: Kate Dale Mental/Physical Health Project Lead Email: kate.dale@bdct.nhs.ukkate.dale@bdct.nhs.uk Angela Moulson Clinical Specialist Lead Adult Mental Health and LD Bradford and Lead GP Email: Angela.moulson@bradford.nhs.uk