In February 2018, NHS England released ‘Improving physical healthcare for people living with severe mental illness (SMI) in primary care’ guidance for Clinical Commissioning Groups (CCGs).

CCGs

CCGs were created following the implementation of the Health and Social Care Act 2012. They are tasked, amongst other things, with the commissioning of services for mental health care and treatment services. One of their primary duties is to improve the quality of the services they provide or commission. There are currently 207 CCGs in England.

Inequality gaps

In the guidance, the NHS highlighted the ‘responsibilities of CCGs to commission services that deliver comprehensive physical health assessments and follow up care to people on the severe mental illness (SMI) register in primary care, addressing the premature mortality experienced by people with SMI compared to the general population.’[1]

According to the NHS, one of the greatest health equality gaps in England is faced by people living with severe mental illness. The report notes that the life expectancy for people with SMI is 15-20 years lower than those without the illness.

NHS England reported that individuals with SMI are not consistently offered appropriate or timely physical health assessments and are not being adequately supported to use available health information and advice.

Good practice

Although the guidance does not provide a specific solution for how physical healthcare for people with SMI should be commissioned and delivered, it does set out what good healthcare provision in primary care must include the following:

1. Completion of recommended physical health assessments

The NHS states that all adults on the SMI register should receive all recommended health assessments as part of a routine check at least annually. If required, these should be undertaken more frequently.

2. Follow-up: delivery of, or referral to, appropriate NICE-recommended interventions

The NHS also states that appropriate evidence-based physical care interventions should be provided for all health risks or conditions identified during the recommended physical health assessment. This should be enabled by way of communication with patients and carers about the follow-up and a referral system to specialists.

3. Follow-up: personalised care planning, engagement and psychosocial support

Personalised care planning is required in order to ensure support to people with SMI to change their lifestyle and behaviour to achieve and sustain health improvements. This involves shared decision-making between the patient and the healthcare professional in order to, amongst other things, take steps to combat loneliness and promote wider engagement in self-care and a healthy lifestyle.

Comments

The guidance document helpfully provides the principles that CCGs need to implement. However it does not stipulate how this should be done as this will vary from area to area. This will also ensure that CCGs have wide discretion as to how changes need to be made in order to eliminate this inequality.

By 2020/2021, NHS England expects CCGs to provide NICE-recommended screening and access to physical care interventions to 60% of the population living with SMI (280,000 people), reflecting the level of funding which will be provided. This would further decrease the health inequalities between the physical health of people living with SMI and those of the general population.

The greater accessibility of physical healthcare services to people living with SMI would also reduce the wider system costs.