Quality standard

Quality statement 6: Assessing physical health

Quality statement

Adults with psychosis or schizophrenia have specific comprehensive physical health assessments.

Rationale

Life expectancy for adults with psychosis or schizophrenia is between 15 and 20 years less than for people in the general population. This may be because people with psychosis or schizophrenia often have physical health problems, including cardiovascular and metabolic disorders, such as type 2 diabetes, that can be exacerbated by the use of antipsychotics. Comprehensively assessing physical health will enable health and social care practitioners to offer physical health interventions if necessary.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults with psychosis or schizophrenia receive comprehensive physical health assessments.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

Process

a) Proportion of adults having treatment for first episode of psychosis who receive a comprehensive physical health assessment within 12 weeks.

Numerator – the number in the denominator who receive a comprehensive physical health assessment within 12 weeks.

Denominator – the number of adults having treatment for a first episode of psychosis.

Data source: Data can be collected using NHS England's Commissioning for Quality Innovation (CQUIN) indicator Improving physical healthcare to reduce premature mortality in people with severe mental illness, indicator 1 and the Royal College of Psychiatrists' National audit of schizophrenia: Audit of practice tool, questions 30 to 39.

b) Proportion of adults having treatment for first episode of psychosis who have a comprehensive physical health assessment 1 year after starting treatment.

Numerator – the number in the denominator who have a comprehensive physical health assessment 1 year after starting treatment.

Denominator – the number of adults having treatment for a first episode of psychosis.

Data source: Data can be collected using NHS England's CQUIN indicator Improving physical healthcare to reduce premature mortality in people with severe mental illness, indicator 1 and the Royal College of Psychiatrists' National audit of schizophrenia: Audit of practice tool, questions 30 to 39.

c) Proportion of adults with psychosis and schizophrenia who have an annual comprehensive physical health assessment.

Numerator – the number in the denominator who have an annual comprehensive physical health assessment.

Denominator – the number of adults with psychosis or schizophrenia.

Data source: Data can be collected using NICE Quality and Outcomes Framework menu indicators IND82 to IND84.

Outcome

Premature mortality of adults with psychosis or schizophrenia.

Data source: Contained within the NHS Outcomes Framework.

What the quality statement means for different audiences

Service providers (such as GPs, community health services and mental health services) ensure that protocols are in place to carry out comprehensive physical health assessments in adults with psychosis or schizophrenia, and share the results (under shared care arrangements) when the service user is in the care of primary and secondary services.

Health and social care practitioners ensure that they carry out comprehensive physical health assessments in adults with psychosis or schizophrenia, and share the results (under shared care arrangements) when the service user is in the care of primary and secondary services.

Commissioners ensure that they commission services that can demonstrate they are carrying out comprehensive physical health assessments in adults with psychosis or schizophrenia, and include this requirement in continuous training programmes. They should also ensure that shared care arrangements are in place when the service user is in the care of primary and secondary services, to ensure that the results of assessments are shared.

Adults with psychosis or schizophrenia should have a regular health check (at least once a year) that includes taking weight, waist, pulse and blood pressure measurements and blood tests. This checks for problems such as weight gain, diabetes, and heart, lung and breathing problems that are common in adults with psychosis or schizophrenia and often related to treatment. The results should be shared between their GP surgery and mental health team.

Source guidance

Psychosis and schizophrenia in adults: prevention and management. NICE guideline CG178 (2014), recommendations 1.5.3.2 and 1.5.3.3

Definitions of terms used in this quality statement

Comprehensive physical health assessments

Comprehensive physical health assessments for adults with psychosis or schizophrenia should focus on physical health problems common in people with psychosis and schizophrenia by monitoring the following:

  • weight (plotted on a chart) – weekly for the first 6 weeks, then at 12 weeks, at 1 year and then annually

  • waist circumference annually (plotted on a chart)

  • pulse and blood pressure at 12 weeks, at 1 year and then annually

  • fasting blood glucose or HbA1c and blood lipid levels at 12 weeks, at 1 year and then annually

  • overall physical health.

Interventions should be offered in line with NICE guidelines on cardiovascular disease, preventing type 2 diabetes, obesity, hypertension, prevention of cardiovascular disease and physical activity. [Adapted from NICE's guideline on psychosis and schizophrenia in adults, recommendations 1.1.2.2, 1.5.3.2 and 1.5.3.3]

Shared care arrangements

Secondary care teams should assess the service user's physical health and the effects of antipsychotic medication for at least the first 12 months or until the person's condition has stabilised, whichever is longer. Thereafter, assessments may be transferred to primary care under shared care arrangements and should take place at least annually. Service users may no longer be under the care of shared care arrangements if they are discharged from secondary care services. [Adapted from NICE's guideline on psychosis and schizophrenia in adults, recommendation 1.3.6.5]