The Long-Term Plan states: ‘People with severe mental illnesses are at higher risk of poor physical health. Compared with the general patient population, patients with severe mental illnesses are at substantially higher risk of obesity, asthma, diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease and make more use of urgent and emergency care. People with a long-standing mental health problem are twice as likely to smoke, with the highest rates among people with psychosis or bipolar disorder.
People with SMI are at a greater risk of poor physical health and have a higher premature mortality than the general population. People with SMI in England:
- Die on average 15 to 20 years earlier than the general population.
- Have 3.7 times higher death rate for ages under 75 than the general population.
- 5 times higher for liver disease
- 4.7 times higher for respiratory disease
- 3.3 times higher for cardiovascular disease
- 2 times higher for cancer
- Experience a widening gap in death rates over time.
The Physical Health SMI Project was set up to develop models of care to proactively engage with patients on GP SMI registers in order offer them their annual physical health-check in a place of their own choice (their home or a community setting) rather than in a GP Surgery. This would be done by providing teams with full sets of mobile physical health check equipment including:
- Point of Care Blood testing device
- Blood Pressure Monitor
- Class III medical scales and tape for BMI measurement
- 4G tablet with template to capture all PHC results and transmit back to GP systems.
The main models of care developed are:
1. Dedicated Physical Health Hub teams:
- In this model a team of clinicians has been employed by the Mental Health Trust or ICS and are ‘embedded’ into the GP Practices
- Have access to Primary Care information systems and identify those in need of the physical health checks from the GP system
- Contact the service user and offer the checks at home or at a location of the patient’s choice
- Carry out all checks and then enter the information onto a 4G enabled tablet provided by the project for this purpose (reducing the need for travelling back to base to enter the information onto office / GP based systems).
2. Use of the equipment by trained Primary Care Staff in the same manner as described above but no dedicated team.
Working closely with Health Call (NHS owned digital health company) the mobile equipment was procured and the tablet template and middleware developed. The equipment has been delivered and training given in the use of the PoC blood testing equipment. In those areas using the health care team / hub model teams have been recruited. Detailed work was carried out to ensure best practice in Clinical Safety and Information Governance was followed at all times.
The equipment is in use by teams in some areas while team recruitment is underway in others.