SystmOne Clinician Support Pack

SEVERE MENTAL ILLNESS

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.

Health Check Elements

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

Table

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 1^st April 2022 and 31^st 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.