Dr Marcus Bicknell GP CALVERTON HILL MEDIUM SECURE HOSPITAL

PHYSICAL HEALTHCARE CHALLENGES IN SECURE SETTINGS

Unexpected death Morbidity and mortality Long term conditions Self-harm Health Promotion Commissioning

Unexpected death Epilepsy Morbid obesity Polytherapy Expect the unexpected (embolism, sepsis) Challenge abnormalities Coroners, CQC, MHC

MORBIDITY AND MORTALITY Treating physical health problems in psychiatric hospital is as important as the treatment of mental illness. Recovering the 20 lost years

LONG TERM CONDITIONS Diabetes Asthma Epilepsy Hypertension and heart disease Computers – QOF - Recall Cancers

SELF-HARM Gender Personality disorder Rotherham, Rochdale, Oxford, Broxtowe Severity GP issues Outcomes Costs Women’s health implications (smears – menstruation)

HEALTH PROMOTION SMOKEFREE PIC QOF – FLUVAC – PNEUMOVAC – CYTOLOGY – DIET – EXERCISE PHYSICAL HEALTH REVIEWS MONITORING PHYSICAL WELL-BEING – ECGs – AMMONIA – CLOZAPINE LIAISON WITH PSYCHIATRISTS

COMMISSIONING Research at Calverton Hill £45,000 Specialised vs CCG vs NHSE Self-harm GP registration 111 / OOH / A and E