Physical Health Checks for people with Severe Mental Illness (PHSMI) data extraction

Overview

NHS Digital is working with NHS England & NHS Improvement (hereafter referred to as NHSE & NHSI) to develop a robust evidence base on which to help shape the future of the Physical Health Checks for people with Severe Mental Illness (SMI). Currently aggregate data is captured manually via Clinical Commissioning Groups (CCGs) and there is insufficient granularity to allow informed decision making.

Data for this evidence base will be extracted at a patient level via the General Practice Extraction Service (GPES) and processed by NHS Digital. This will include linkage with Independent Group Advising on Release of Data (IGARD) approved linkage with the Mental Health Standard Data Set, (MHSDS), and the Hospital Episode Statistics (HES). NHS Digital will disseminate pseudonymised data to NHSE & NHSI allowing analysis to:

• help monitor health outcomes to understand whether delivery of physical health checks and follow-up interventions lead to improvements in physical health indicators in people with SMI over time, including whether any given patient retains improvements in subsequent annual health check cycles
• inform whether current policy and practice exacerbate or reduce health inequalities, including an insight into which patient cohorts are accessing health checks and interventions, and whether these have the same impact in different cohorts
• review whether different risk factors (for example SMI diagnosis, demographics, socioeconomic status, or frequency of contacts with primary and secondary care) can be utilised to inform risk stratification of physical health checks and determine the style or frequency of checks appropriate for various patient cohorts
• assess and address local inequalities in access to and uptake of physical health checks and interventions, informing a targeted approach to improve service provision on national and local levels
• help understand the impact of health checks on healthcare utilisation and the subsequent cost effectiveness of delivery.

Extracting via GPES means that there will be no additional data burden for GPs. GPES will extract identifiable patient level data, which will be held by NHS Digital.

An initial full-year extract, 1 April 2019 – 31 March 2020, is scheduled to take place in the second half of the 2020-21 financial year. Subsequent extracts are required on a quarterly basis.

NHS Digital is seeking acceptance of its plans for the data extract from the Data Coordination Board (DCB). As part of the assurance process, DCB has requested appropriate consultation is undertaken, with the members of the Joint GP IT Committee, to obtain feedback on the technical design of the extraction.

Why your views matter

While aggregate manual data collections have allowed for tracking progress against key programme deliverables, they are more burdensome and at the expense of richer, more granular data sets that could be used to analyse the impact of current policy and practice on the physical health of people with SMI.

Central programme investment in the GPES collection serves as an opportunity to collect more intricate, patient record-level data that would enable national monitoring of key NHS LTP commitments to address the stark inequalities in life expectancy faced by people with SMI.

Record-level information of interest includes data on the delivery of individual elements of the comprehensive physical health check, data on the delivery of the relevant follow-up interventions, demographic data and socioeconomic location via post-code proxy.

The data collection links to CCGs’ Statutory functions, responsibilities and commitments to, alongside other bodies, improve and integrate services providing physical healthcare, reduce health inequalities and reduce premature mortality across people with SMI, in line with the relevant legislation including the Public Sector Equality Duty, the Equality Act 2010, and the Health and Social Care Act 2012.

The data will be used to monitor the implementation and impact of commitments to close the mortality gap for people with severe mental illness.

Without this data it will not be possible to articulate whether the commitment is being met, additionally it will not be possible to:

• monitor local and national progress towards the headline commitment within the NHS LTP to improve physical health outcomes for people with severe mental illness (and therefore closing a notable health inequality; the premature mortality rates of approx. 15-20 years for people with SMI).
• monitor local and national progress towards the NHS LTP commitment, and therefore target efforts to drive up CCG investment and quality improvement. Therefore, the data sought is crucial to ensuring visibility of the variation in CCG and provision, and to feed into a risk stratification model to use to identify where to target CCG level intervention.

The business rule set has been developed to ensure that only the necessary data is extracted for one clearly defined cohort:

The patients, of any age, with a diagnosis of schizophrenia, bipolar affective disorder, and other psychoses up to and including the reporting period excluding patients recorded as ‘in remission’.

Data will be extracted for the following NICE-recommended checks and interventions:

1. A measurement of weight (BMI or BMI + waist circumference).
2. A blood pressure and pulse rate check.
3. A blood lipid including cholesterol test.
4. A blood glucose test.
5. An assessment of nutritional status, diet, and level of physical activity.
6. An assessment of alcohol consumption.
7. An assessment of smoking status.
8. An assessment of use of illicit substance / non prescribed drugs.
9. Access to relevant national screenings – breast cancers, bowel cancers and cervical.
10. Medication reviews.
11. Relevant interventions relating to health checks for example weight management, diabetes structured education programme, smoking, alcohol, and illicit substance abuse.

Futher information can be found in the specification document attached at the bottom of the page.

In 2016, The Five Year Forward View for Mental Health (MHFYFV) set out NHSE & NHSI’s approach to reducing the stark levels of premature mortality for people living with severe mental illness (SMI) who die 15-20 years earlier than the rest of the population, largely due to preventable or treatable physical health problems. In the MHFYFV NHSE & NHSI is committed to leading work to ensure that “by 2020-21, 280,000 people living with SMI have their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and intervention each year”. This equates to a target of 60% of people on the General Practice SMI register receiving a full and comprehensive physical health check across primary and secondary care. This ambition was reiterated in the NHS Long Term Plan (NHS LTP) and associated Mental Health Implementation Plan, with the commitment to increase the number of people receiving physical health checks to an additional 110,000 people per year (in addition to the current 280,000 Five Year Forward View ambition), bringing the total to 390,000 checks delivered each year.

 The data set will be used to track delivery against the NHS LTP commitment and aggregate counts on the number of physical health checks and interventions delivered (that is the number of people on the GP SMI register in receipt of individual physical health checks and interventions).