Health Innovation Manchester is looking at new ways to boost the physical health of people with severe mental illness by providing access to innovative point of care physical health testing.

Greater Manchester has approximately 25,000 people with severe mental illness (SMI), with these people more likely to experience significantly poorer health and shorter life expectancy compared with the general population. The population who suffer from severe mental illness have premature mortality rates (death under 75 years) 3.7 times higher than the general population and die on average 15-20 years earlier. It is estimated that two-thirds of these deaths are from preventable physical illnesses including diabetes, hypertension, cardiovascular and respiratory disease.

The stark inequalities in premature mortality for people with SMI are related to a combination of factors including^:

• Increased cardiovascular risk factors including poor diet, physical inactivity, smoking and substance misuse.
• Side effects of medication
• Poorer access and adherence to treatment
• Delayed disease diagnosis and leading to lower survival rates
• Social determinants of health and consequences of living with an SMI, such as poverty, unemployment, and stigma

Furthermore, the use of anti-psychotic medication for SMI is linked to a number of metabolic side-effects including weight gain, high blood pressure, high blood sugar, cholesterol and an increased risk of developing obesity, hypertension, diabetes and Coronary Heart Disease (CHD).

Consequently, compared with the general patient population, patients with SMI have substantially higher prevalence of asthma, diabetes, chronic obstructive pulmonary disease (COPD), CHD and stroke.

Annual Physical Health Checks for people with SMI

All patients with a SMI diagnosis are entitled to a physical health check every year. Primary Care is responsible for carrying out the annual physical health assessments and follow up care for patients who are either not in contact with secondary mental health services or have been in contact for more than 12 months and their condition has stabilised. NHS England has mandated that SMI patients should have an annual physical health check (APHC) once a year. Currently GM is delivering 25% of these, compared to a national aspiration for 60% completion.

To improve this, Health Innovation Manchester is working with the 66 PCNs across GM to roll-out digital point of care testing devices to enable PCNs to conduct more tests, quicker and more easily with faster results. In addition, previously, Primary Care staff had to go into individual GP records to find patient lists of eligible patients to invite for tests. However, a dashboard has been created within the GM Care Record that has significantly streamlined this process.

The physical health checks themselves are just the start of the process with new models of care being developed by PCNs to support people with SMI including access to wider support and welfare services. Different models of care are being adopted across PCNs, however, the basic process is as follows:

1 – The physical health assessment including:

• Weight, BMI, nutritional status, and diet
• Blood pressure and pulse check
• Blood lipid including cholesterol test
• Blood glucose test or HbA1c
• Alcohol, smoking status and tobacco use
• Medicines review
• General physical health enquiry into sexual health, oral health and substance misuse
• Access to national screening and immunisation programmes

NOTE: Items in bold are mandated as part of NHSE SMI Annual Physical Health Check.

2 – Delivery of, or referral to, interventions for health risks identified during the assessment:

• Obesity prevention/physical activity
• Hypertension
• Type 1 diabetes diagnosis and management
• Type 2 diabetes prevention and treatment
• Lipid modification
• Smoking cessation and substance misuse programmes

3 – Personalised care planning to achieve physical health improvements, including:

• Shared decision making to agree a personalised care plan and goals
• Health coaching to co-produce behavioural change programme and engagement in self-care
• Social prescribing to promote engagement with the wider community
• Support from care workers to attend appointments and reduce barriers to service engagement
• Welfare support such as debt advice, food banks and housing and other determinants of health
• Proactive follow-up on the results of all assessments and outcomes of referrals

Results of the project are due in 2023, but in the meantime, using the devices and the new models of care, one PCN in Greater Manchester has reported the number of their SMI patients having an annual physical health check has increased from 20% to over 65%.