1. NIMHE, Primary Care Programme
nGMS and Mental Health
NIMHE, Primary Care Programme

2. Where does Mental Health fit?
Quality and Outcome Framework
National Enhanced Service for Depression
Patient satisfaction questionnaire
Medicine Management
Significant Event Monitoring

3. Quality and Outcome Framework
41 points of 550 are related to severe mental illness
Different to other clinical domains – patient has to agree to be included
Three parts:
Develop a register
Monitor physical health
Manage lithium appropriately

4. The Q & O Domain Indicator Points Payment Stages
Register of people with a severe long term mental illness 7
Percentage of patients with a review recorded in the last 15 months 23
25 – 90%
Percentage of patients on lithium with a record of lithium in last 6 months 3
Percentage of patients on lithium with a record of renal and thyroid function
Percentage of patients on lithium with a recorded lithium within therapeutic range
25 – 70%

5. Develop a register Who to include? What to call it?
People with schizophrenia and bipolar affective disorder
On a case by case basis for others with significant mental
health and physical health needs
What to call it?
Be aware that registers ( e.g.like supervision registers) mean
something different to users

6. How? Search by diagnosis Search by therapeutic category Ask the PHCT
Schizophrenia Eu 20.0
Bipolar disorder Eu 31.0
Search by therapeutic category
Ask the PHCT
Ask the CMHT
Label with 9H8
Label those who do not wish to be included 9H7

7. Why do it? SMR for schizophrenia and bi-polar disorder is about 200
Cardiovascular and respiratory disease SMR is 400
Diabetes is 5 times as common
90% of people who have schizophrenia smoke (30% of people with bipolar disorder)
Drug and alcohol misuse
HIV is 8 times as common
HCV is (perhaps) 15 times as common

8. What to do? Physical health review Medication review
Communication review

9. Physical Health Cardiovascular disease Diabetes and obesityBP
History of arrhythmias
Diabetes and obesity
Urine analysis or blood glucose?
Respiratory disease
Peak flow
Health Promotion
Smoking
Substance/alcohol misuse
Cervical cytology
Influenza?
HIV/HCV?

10. Medication Review – 8B3S
Review what medication (all) is supposed to be prescribed
What is the patient actually taking?
Is the patient taking any OTC medication?
Review side-effects, interactions etc
Review concordance
Consider referral to CMHT if medication has not been reviewed in the last 5 years by psychiatrist

11. Communication Review Name of Key worker (if known to CMHT)
Contact details for key worker in office hours and in emergencies/OOH
Contact details for carer (if the patient has nominated a carer)

12. Lithium Review
Proportion that have had their lithium level checked in the last six months
Serum lithium 44W8%
Proportion that have had their renal and thyroid function tested in the last six months
Thyroid function tests 442%
Serum Creatinine 44J3%
Proportion that have their lithium level within the therapeutic range

13. NES for Depression
What is it?
How much will it cost?
Who can do it?

14. NES Depression – What is it?
Essential or additional services delivered to a higher specified standard
Commissioned by PCTs
Generally placed with GMS/PMS providers but need not be [2.15(iv)]
Can be provided by the PCT itself [2.38 – 2.43]

15. NES Depression – What is it?
Aim: To meet main recommendations of Defeat Depression Campaign.
Definition of Depression: Clinical judgement and evidence based diagnostic skills
Service Outline:
Register of patients
Multi-disciplinary approach
Use CBT
Use screening procedures
Undertake training
Maintain personal health plans
Make referrals/enquiries
Review and feedback

16. NES Depression – ££££ ? For a PCT population:
Use ONS data for prevalence
Calculate % of patients between 16 – 65
Weight the target population by the DH Mental health index
Assume only 50% identified
Assume that 90% will be treated in primary care
Multiply that total by £100.00
Light the blue touch paper and retire!

17. NES Depression – Who can do it?
GMS/PMS primary health care teams
Mental health providers
Voluntary Sector organisations
PCO itself [2.44 – 2.46]

18. Patient Satisfaction Questionnaire
Length of consultation
10 min booked, 8 min open surgery
30 points
Undertaken an approved survey annually
40 points
Undertaken the survey and reflected on changes if appropriate
15 points
Undertaken approved survey, discussed results as a team, an d with patient group of NED of PCT, and proposed changes with some evidence that some had been enacted

19. Patient Satisfaction Questionnaire
There is no approved questionnaire that is specific to mental health
Yet
NIMHE Primary care programme is developing such a questionnaire, which will need to be tested for face validity etc, and then approved by the National Panel.
Available in 12 months?

20. Medicine Management 10 indicators
Medicine 7 is specific to mental health – 4 points
“Where the practice has responsibility for administering regular injectable neuroleptic medication, there is a system to identify and follow up patients who do not attend”

21. Medicine Management Practice Guidance Written evidence
Good to involve CPN (if available)
Relatively small numbers
Written evidence
Grade C i.e. optional
Assessment Visit
Practice should be able to demonstrate system
Assessors Guidance
If the patient is under the care of the mental health team, and receives the medication from the team, then they should be excluded from the practice responsibility.

22. Significant Event Monitoring
Part of Organisational Indicators – Education
9 indicators
Education Significant events in 3 years – 4 points
Education 7 – should include the following (if they have occurred)
Any death on practice premises
2 new cancer diagnoses
2 deaths which occurred as part of terminal care
1 patient complaint
1 suicide
1 Mental Health Act assessment

23. Significant Event Monitoring
In line with RCGP Occasional Paper. Reports should be laid out in one of two forms:
Description of Event
Learning outcomes
Action plan
What happened?
Why did it happen?
Was insight demonstrated?
Was change implemented?
Non confrontational, multi disciplinary team activity

24. In conclusion Quality and outcome framework
Severe and enduring mental health
41 points
NES Depression
Depression
£100 per pat.
Patient Experience Questionnaire
Mental health (?) patients
100 points
Medicine Management
Those on depot neuroleptics
4 points
Significant Event Monitoring
Suicide and/or MHA Assessments