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British Journal of General Practice

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Why all GPs should be bothered about Billy

Carolyn Chew Graham, Anand J Chitnis, Paul Turner, Alex J Mitchell, Sheila Hardy and David Shiers
British Journal of General Practice 2014; 64 (618): 15. DOI: https://doi.org/10.3399/bjgp14X676339
Carolyn Chew Graham
GP Manchester, Professor of General Practice Research, Keele University, and RCGP Curriculum Guardian, Mental Health.
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Anand J Chitnis
Chair and Mental Health Lead, Solihull CCG.
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Paul Turner
GP Karis Medical Centre Birmingham; Mental health and wellbeing lead for Edgbaston network Birmingham South Central CCG.
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Alex J Mitchell
Consultant Psychiatrist, University of Leicester.
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Sheila Hardy
Education Fellow, UCL, Partners and Visiting Fellow, University of Northampton.
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David Shiers
Retired GP North Staffordshire and carer of daughter with schizophrenia. E-mail:
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  • For correspondence: david.shiers@doctors.org.uk
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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.

Notes

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

  • © British Journal of General Practice 2014

REFERENCES

  1. 1.↵
    1. BMA
    General practice contract changes 2014–2015. http://bma.org.uk/news-views-analysis/general-practice-contract/qof-changes-2014 (accessed 4 Dec 2013).
  2. 2.↵
    1. Brown S,
    2. Kim M,
    3. Mitchell C,
    4. Inskip H
    (2010) Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry 196:116–121.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Royal College of Psychiatrists
    (2012) Report of the National Audit of Schizophrenia (NAS) 2012 (Healthcare Quality Improvement Partnership, London).
  4. 4.↵
    1. Lester H,
    2. Shiers DE,
    3. Rafi I,
    4. et al.
    (2012) Positive Cardiometabolic Health Resource: an intervention framework for patients with psychosis on antipsychotic medication (Royal College of Psychiatrists, London).
  5. 5.↵
    1. Lester H
    (2013) The James Mackenzie Lecture 2012. Bothering about Billy. Br J Gen Pract doi:10.3399/bjgp13X664414.
    OpenUrlFREE Full Text
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British Journal of General Practice: 64 (618)
British Journal of General Practice
Vol. 64, Issue 618
January 2014
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Why all GPs should be bothered about Billy
Carolyn Chew Graham, Anand J Chitnis, Paul Turner, Alex J Mitchell, Sheila Hardy, David Shiers
British Journal of General Practice 2014; 64 (618): 15. DOI: 10.3399/bjgp14X676339

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Why all GPs should be bothered about Billy
Carolyn Chew Graham, Anand J Chitnis, Paul Turner, Alex J Mitchell, Sheila Hardy, David Shiers
British Journal of General Practice 2014; 64 (618): 15. DOI: 10.3399/bjgp14X676339
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