NHS England » VCSE outreach supporting person-centred SMI physical health checks

This case study is an example of the collaborative work taking place to deliver physical health support services for people living with severe mental illness (SMI). It is one of a collection of case studies that support our guidance for integrated care systems on Improving the physical health of people living with severe mental illness, published in January 2024.

Organisations: Hillingdon Mind, North West London ICS and The Confederation Hillingdon CIC.

Aim and rationale

Based on feedback from people with lived experience in the area, the aim was to better support those invited to an SMI physical health check by their GP to take up this offer. The service developed a SMI physical health check model that is person centred and links people into wider sources of support by involving voluntary, community and social enterprises (VCSEs) like Hillingdon Mind.

Development and implementation

Feedback forums with those with lived experience in the area identified a range of barriers to receiving their annual physical health checks. These included some primary care staff not understanding the difficulties service users experience in engaging with the check, and a lack of clear information on what to expect from a check and how to book it.
Based on this feedback, primary care training in mental health first aid was introduced, with a focus on severe mental illness. Hillingdon Mind also wrote a new invitation letter for GP surgeries in the area to send.
If a patient does not respond to an invitation, the GP can refer the patient to Hillingdon Mind. This service will then send the patient a letter and resources explaining what the check involves and the support it can provide, and highlighting that the patient should expect to receive a call from Hillingdon Mind, with a text message sent ahead of the phone call.
In the phone call Hillingdon Mind staff explain the check, answer any questions and offer to book the appointment on the patient’s behalf. They can also liaise with primary care staff and attend the appointment with the patient. Hillingdon Mind has also encouraged primary care staff conducting the SMI physical health checks to complete a wellbeing action plan with the patient, so that patients can set realistic goals around their general health and wellbeing, be given clear targets and support options, and are signposted to relevant services within their community.
Hillingdon Mind staff attend multidisciplinary meetings with GP surgeries to discuss caseload, patient progress and feedback, and identify strategies to engage with non-attendees.
Hillingdon Mind staff also attend roadshow events to promote the service to primary care network (PCN) staff and community wellbeing events to reach out to patients living with SMI and their carers/families.

Overcoming challenges

Referral numbers were affected by GP surgeries prioritising other health campaigns. To overcome this, the service was promoted to those PCNs not using the Hillingdon Mind service. Some asked Hillingdon Mind to run presentations about the service. Referrals have since increased.
Some patients have to wait longer than expected for an SMI health check appointment. Hillingdon Mind keeps in contact with the patient during the wait for the health check to keep them motivated to attend.
Support was found to be limited for patients with additional needs, including physical disabilities or where English is not their first language. Hillingdon Mind flags additional needs to the GP surgery, encourages GP surgeries to provide accessible resources in key community languages, and advocates on behalf of patients for interpreters to be provided when requested. Hillingdon Mind has also assisted individual GP surgeries to book home visits where possible for those with physical disabilities or anxiety about attending a GP surgery.

Outcomes

In 2022/23, Hillingdon Mind engaged with 190 patients and attended 88 appointments with 48 patients (the health check may not be completed at one appointment). 65% of clients engaging with Hillingdon Mind went on to have their SMI physical health check.
Patients reported they appreciated the clear information, advocacy within appointments and the wellbeing action plans.
The cultural competence of Hillingdon Mind staff has helped increase engagement with patients from a similar ethnic background.

Recommendations

Delivery of SMI physical health checks requires integration and inter-professional working between primary care, VCSE organisations and other sectors.
Support needs to be tailored to the individual, including by making a range of reasonable adjustments, such as home visits.
Based on feedback from patients, GP surgeries should consider the timing of appointments (more people favour afternoon appointments) and longer appointments so the check can be completed in one appointment and people do not require a follow-up appointment.

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