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.
- BP & Pulse
- BMI/Waist Circumference
- Assessment of smoking status
- Assessment of alcohol use (Using AUDIT tool if required)
- Blood lipid including cholesterol
- Blood glucose test (HBA1c or Glucose)
- Assessment of nutritional status, diet, and level of physical activity
- Assessment of use of illicit/non-prescribed drugs
- Medication Review
- Access to relevant national screening programmes
- General enquiry into sexual health
- 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 |
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.