Clinical:
SMI PHC are available to anyone with SMI. Those eligible for an annual physical health check are all people with a recorded diagnosis of psychosis, schizophrenia or bipolar affective disorder (MH1_REG). Those with a lithium prescription in the last 6 months (QOF register MH2_REG) are not included for annual SMI physical health checks in QOF unless they also have a diagnosis of schizophrenia, bipolar and other psychoses. However, all patients taking antipsychotics or mood stabilisers (regardless of whether they are on the SMI register or not) should have medication reviews and their physical health monitored in line with summary of product characteristics and/or British National Formulary guidelines on:
General practice teams are responsible for carrying out annual physical health assessments and follow-up care for:
- Patients with SMI who are not in contact with secondary mental health services, including both:
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- those whose care has always been solely in primary care;
- those who have been discharged from secondary care back to primary care; and
- Patients with SMI who have been in contact with secondary care mental health teams (with shared care arrangements in place) for more than 12 months and/or whose condition has stabilised.
Secondary care teams are responsible for carrying out annual physical health assessments and follow-up care for:
- Patients with SMI under care of mental health team for less than 12 months and/or whose condition has not yet stabilised;
- Mental health inpatients. [NG178]
From 2024/25 NHS England has set out that 75% of people who are eligible for a SMI PHC should receive one each year.
It is recommended to deliver a more comprehensive annual physical health check, one that also includes:
- Medical and family history
- Blood-borne virus and liver function screening
- Cardiovascular risk assessment (including QRisk [NG238]). NICE guidelines have been updated in December 2023 for the assessment and care of adults who are at risk of or who have cardiovascular disease (CVD), such as heart disease and stroke to include the QRISK 3 tool. This is particularly important for people taking atypical antipsychotics or people with severe mental illness because QRISK2 does not take these risk factors into account and so may underestimate the 10‑year CVD risk in these populations. Until electronic clinical systems in which QRisk2 is embedded are updated to QRisk3, it may be necessary to use the online version of QRISK3.
- Relevant national immunisation programmes
- Support to access relevant national screening programmes, including cancer screening
- Oral health advice and brief interventions
- Assessment of physical activity levels
- Sexual and reproductive health assessment and advice (including contraception)
- Substance misuse assessment
- Medicines reconciliation and monitoring
Various online training is available for professionals delivering physical health checks, including:
Available guidance on physical health checks:
Local support in Norfolk and Waveney is available to help those with SMI to improve their physical health, you can find out more in the box below.
Administrative and Coding:
In Norfolk and Waveney we recommend Arden’s templates is used for recording SMI PHCs.Support to create searches to find patients with an outstanding SMI PHC on Arden’s templates can be found at the following:
General Practices are responsible for keeping an up to date (‘validated’) SMI register, including the appropriate use of ‘in remission’ codes. Validating SMI registers on an annual basis should mean that registers are approximately accurate and up to date unless a practice has a high patient turnover necessitating more frequent validation. Validation is important for ensuring that the right people are invited for an annual physical health check.
- People who are in remission will remain on the SMI register in case of relapse but are not expected to be invited for an annual physical health check.
- A remission code (under the SNOMED cluster MHREM_COD) should only be applied if for at least five years, the patient has all of the following:
- No record of anti-psychotic or mood stabiliser medication;
- No mental health in-patient episodes;
- No secondary or community care mental health follow-up.
Please note the above definition of remission is for guidance. There may be a small group of patients who have not had any of the above, who are seen solely in primary care and who are still unwell and should not be coded as in remission. Clinical discretion should be applied. For further information please refer to the technical guidance.
SMI PHC primary care codes and information on QOF indicators can be found below:
From 2024/25 primary care data will be automatically extracted through the General Practice Extraction Service (GPES), reducing burden on practices who currently upload data through the Strategic Data Collection Service.
The SMI Suffolk Physical Health Team at Norfolk and Suffolk Foundation Trust have created the following training video for coding SMI PHCs - watch it here.
Improving Access to SMI PHC – Outreach Service and promotional materials:
Norfolk and Waveney ICB have commissioned Together for Mental Wellbeing to provide outreach support to people living with Severe Mental Illness (SMI) to access their 1) annual physical health check 2) COVID vaccination 3) and/or flu vaccination. Together can provide the following:
- Support and encouragement for people to book the appointment
- Booking the appointment (where practice allows)
- Funding and booking taxi transportation to and from the appointment
- Providing people with information on health checks, COVID vaccination and flu vaccination via letter or telephone e.g. NHS published resources or co-produced materials from organisations such as Equally Well UK
- Offering advocacy via video call
If you would like to take up this offer of outreach support please contact together.smiproject@nhs.net in the first instance.
Co-produced leaflets and posters are also available for use within primary care within Norfolk and Waveney. To download these please contact: nwicb.mentalhealthteam@nhs.net
