People with serious mental illness such as schizophrenia and bipolar disorder are much more likely to suffer from physical illnesses. Many of these illnesses can be prevented if detected early. The first point of contact with the NHS for people with serious mental illness is usually the GP. To promote earlier detection of physical health problems, the NHS pays GPs to conduct reviews of their patients’ physical health every year including seven checks: cervical screening, alcohol consumption, smoking status, blood pressure, cholesterol, body mass index, and blood glucose. Despite the financial incentives offered to GPs, not every patient receives annual health checks. Increasing the number of people receiving health checks has become a high policy priority for the NHS.
We will assess the quality of health checks by looking at whether they trigger appropriate interventions (e.g. medication for high blood pressure). We will explore reasons for why health checks may vary in quality such as being conducted under time pressure or by practices with specific characteristics.
We will also investigate why some patients don’t receive physical health checks. We will construct their profiles based on age, gender, medical conditions, and whether they live in deprived areas. This will inform policymakers about whom to target. Another reason that may lead to patients not receiving annual health checks is that since 2014, GPs are not paid anymore for conducting three of the checks. Our analysis will explore the effect of this policy change on whether physical health checks are still undertaken.
Background
To promote physical health monitoring, the Quality and Outcomes Framework (QOF) provides financial rewards to GPs to conduct an annual review of the patient’s physical health including seven physical health checks (PHCs): cervical screening, alcohol consumption, smoking status, blood pressure, cholesterol, body mass index, and blood glucose. Despite the incentives provided, not every patient receives annual PHCs. Increasing the uptake of PHCs for people with Serious Mental Illness (SMI) has become a high policy priority for NHS England.
Objectives
Our objective is to provide a detailed understanding of the quality and uptake of PHCs for people with SMI. We expect this work to impact on policymakers by providing detailed information about the content and delivery of PHCs, and guide GPs and commissioners on developing personalisation approaches of whom to target to increase uptake of PHCs.
Methods
We will undertake patient-level analysis using primary care data from the Clinical Practice Research Datalink for the financial years 2006-2020.
First, we will assess the quality of PHCs based on whether they trigger appropriate interventions. PHCs and related interventions will be identified by relevant clinical codes. We will use descriptive analysis to present variation in quality across PHCs and to what extent quality differences are associated with patient characteristics, organisational factors, and PHCs being recorded close to the QOF reporting period deadline.
Second, we will explore factors that constitute barriers to receiving PHCs thus generating health inequalities. We will employ semi-parametric Cox hazard models to examine how patient and practice characteristics affect the timing of receiving a PHC. We will employ differences-in-differences methodology to assess the impact of removing financial incentives from three PHCs on uptake. We will use interrupted times series to assess the impact on uptake of a policy requiring clinical commissioning groups to report on the delivery of PHCs.
Interventions following Physical Health Checks in primary care; Probability and timing of receiving Physical Health Checks in primary care; Uptake of Physical Health Checks
Panagiotis Kasteridis - Chief Investigator - University of York
Panagiotis Kasteridis - Corresponding Applicant - University of York
Luis Fernandes - Collaborator - University of York
Maria Jose Aragon Aragon - Collaborator - University of York
Najma Siddiqi - Collaborator - University of York
Nils Gutacker - Collaborator - University of York
Rowena Jacobs - Collaborator - University of York
ONS Death Registration Data;Patient Level Index of Multiple Deprivation