SystmOne Clinician Support Pack

SEVERE MENTAL ILLNESS

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BACKGROUND

This pack has been developed in association with GPA and WORTH to assist clinicians with use of the Ardens template during Severe Mental Illness Annual Health Checks.

People with Severe Mental Illnesses (SMI) include any person with diagnoses of schizophrenia, bipolar affective disorder, other psychoses, and any patient on lithium therapy.

People with SMI:

  • can expect to die 15-20 years earlier than those with no SMI diagnosis.
  • 65% will die from a preventable physical illness – most likely cardiovascular disease, respiratory diseases, diabetes, or hypertension.
  • are 4 times more likely to develop long term physical health conditions, and 10 times more likely to be hospitalised because of those conditions.
  • are 3 times more likely to attend A&E with an urgent physical health need.
  • are 3 times more likely to smoke.
  • are 3.5 times more likely to lose all teeth.
  • have double the risk of obesity and diabetes, 3 times the risk of hypertension and metabolic syndrome, and 5 times the risk of dyslipidaemia.

Northamptonshire are currently delivering a six-point Annual Health Check to approximately 15% of the cohort, which is within the lowest quartile in the Midlands. In line with the NHS Long Term Plan to improve outcomes for patients with SMI and increase levels of achievement for the QOF Annual Health Check, the ICB have introduced a local incentive scheme in Northamptonshire.

CORE ELEMENTS

The Local Incentive Scheme includes the usual six-point QOF check, with an additional six checks and any follow up interventions as required. All twelve elements and relevant follow up interventions will need to be coded.

  1. BP & Pulse
  2. BMI/Waist Circumference
  3. Assessment of smoking status
  4. Assessment of alcohol use (Using AUDIT tool if required)
  5. Blood lipid including cholesterol
  6. Blood glucose test (HBA1c or Glucose)
  7. Assessment of nutritional status, diet, and level of physical activity
  8. Assessment of use of illicit/non-prescribed drugs
  9. Medication Review
  10. Access to relevant national screening programmes
  11. General enquiry into sexual health
  12. General enquiry into oral health

ARDENS TEMPLATE

STEP 1)

Start the SMI HC consultation in SystmOne by selecting the SMI icon in the patient demographic box.

STEP 2)

Outstanding actions are displayed as alerts on the ‘Home’ tab. Once you have completed the review, click ‘Ok’ and reopen the template to identify any missed actions.

STEP 3)

Work through the ‘Review – Physical Health’ tab as you complete the review.

ASSESSMENT AND FOLLOW UP INTERVENTION RECOMMENDATIONS

SMI HC Item Item Descriptor Recommended  Codes Additional Tools Follow Up Interventions
Core 1 BP and Pulse BP and Pulse

OR

BP Refused

BP Template As clinically indicated
Core 2 BMI/Waist Circumference Height, Weight, BMI, Waist Circumference

OR

Weight declined

BMI Calculator Referral to weight management service

OR

Referral to weight management service declined

Core 3 Assessment of smoking status Never smoked tobacco

Passive smoker

Never smoked tobacco

Ex-smoker

Light, moderate, heavy or very heavy smoker

OR

Refusal to give smoking status

Smoking Template Smoking cessation advice

Referral to stop smoking clinic

OR

Smoking cessation advice declined

Core 4 Assessment of alcohol use Lifetime non-drinker

Current non-drinker

Lower risk drinking

Hazardous or harmful alcohol use

OR

Declines to state current alcohol consumption

Alcohol Screening Template

AUDIT C

AUDIT (for Audit C score >5)

Advice on alcohol consumption

Referral to specialist alcohol treatment service

OR

Declined referral to specialist alcohol treatment service

Core 5 Blood lipid including cholesterol Coded upon BT/Result filing

OR

Cholesterol declined

Phlebotomy Template

ICE

QRISK2

CVD Risk Score

As clinically indicated

Core 6 Blood glucose test

(HBA1c or Glucose)

Coded upon BT/Result filing

OR

Glucose test declined

Diabetes Review Template As clinically indicated
Extra 1a

 

 

 

 

Extra 1b

 

 

 

 

 

Extra 1c

Assessment of nutritional status,

diet, and

level of physical activity

Diet good, average, or poor

Gets no exercise

Enjoys light, moderate, or heavy exercise

OR

Exercise assessment declined

Malnutrition Universal Screening Tool

Physical Activity Questionnaire

Lifestyle advice regarding diet

Referral to dietetics service

OR

Referral to dietician declined

Lifestyle advice regarding diet

OR

Refer to weight management programme

Patient given exercise advice

Referral to exercise on referral programme

OR
Declined referral for physical exercise programme

Extra 2 Assessment of use of illicit/non-prescribed drugs Does not misuse drugs

Misused drugs in the past

Misuses drugs

OR

Drug misuse assessment declined

Referral to substance misuse service

OR

Referral to substance misuse service declined

Extra 3 Medication Review Mental health medication review Drug Review

GASS

As clinically indicated
Extra 4 Access to relevant national screening programmes Screening advice for all eligible programmes Cancer Screening Template Book screening appointment if available
Extra 5 General enquiry into sexual health Sexually active

Not sexually active

Never sexually active

Sexual Health Template General contraceptive advice given
Extra 6 General enquiry into oral health Good oral hygiene

Poor oral hygiene

Oral Health Template Oral health advice given

Signposting to dentist

Referral to dentist

FREQUENTLY ASKED QUESTIONS

Q. How long does an SMI HC take?
A. The recommended appointment length is 30 minutes.

Q. Do all elements of the review need to be coded on the same day?
A. No. The codes can be on separate days between 1st April 2022 and 31st March 2023.

Q. Does the patient need to attend cancer screening appointments to meet the Annual Health Check targets?
A. No, provided the correct code for screening advice is added during the review.

Q. Is there more training available for Ardens or Ardens Manager?
A. Ardens offer several training packages available and a comprehensive online support centre.

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