The 2014–2015 QOF overhaul1 retires three critical cardiometabolic indicators from the severe mental illness (SMI) domain, keeping only blood pressure. Yet cardiovascular disorders, rather than suicide, remain the single biggest contributor to 15–20 years reduced life expectancy. Two decades of cardiometabolic risk prevention has successfully reduced cardiovascular mortality in the general population but sadly eluded those with SMI.2
Potentially modifiable cardiometabolic risks, often appearing within weeks of commencing antipsychotics, ultimately translate into 1.5–3-fold increased rates of diabetes, obesity, and dyslipidaemia than in the general population. By age 40 years metabolic syndrome becomes four times commoner and about 40% of individuals are biochemically at high risk of diabetes. Furthermore the National Audit of Schizophrenia3 found only 29% of 5091 patients from across England and Wales had cardiometabolic risk adequately assessed in the previous 12 months (weight, smoking status, glucose, lipids, BP). Weight was unrecorded in 43%. Moreover when cardiometabolic complications are discovered, too often these are ignored in clinical practice particularly when compared with patients without mental illness.
Responding to this evidence of inequalities in care, the Lester Positive Cardiometabolic Resource4 embraced these to-be-retired QOF measures with the message ‘Don’t just screen, intervene’. This was endorsed by the RCGP/RCPysch/RCP/RCN/Rethink/Diabetes UK and recommended by NICE (NICE CG 155) and the Schizophrenia Commission. The resource’s lead author, the late Professor Helen Lester, key scientific advisor to the QOF until her death this year, challenged us to be ‘Bothered about Billy’5 in the RCGP James McKenzie Lecture 2012.
QOF aims to universalise good quality care. The challenge is in its translation from checklist to the human being in front of us. Has anyone explained to a real person with SMI or their relatives why these indicators are being removed? Ultimately our responsibility is to First do no harm and provide a service that makes sense. This decision does neither.
We would ask the 2014–2015 GP contract negotiators to join us in being bothered about Billy too.
Competing interests
David Shiers is a current member of the Guideline Development Group for NICE guidance for adults with psychosis and schizophrenia; David Shiers and Carolyn Chew Graham are members of NCCMH board
REFERENCES
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