Mental Health in Scotland: Improving the Physical Health and Well Being of those Experiencing Mental Illness

Annex B General Medical Services Contract for Primary Medical Services⁵⁸

Since 2004 additional resources have been provided to deliver high quality and consistency of primary care healthcare services.

These have been made through the General Medical Services ( GMS) contract by setting standards to address the management of illness, undertake health promotion and health protection, ill health prevention and improvement of health and public health. The expectation is that individuals' health is managed in the social context of their families/carers and the community in which they live.

The impact is monitored through the Quality and Outcomes Framework ( QOF), which is published annually.

The contract includes; the provision of essential services; additional services; QOF and enhanced services. The first two are largely compulsory. The QOF and some enhanced services are optional. Enhanced services are commissioned at the discretion of NHS Boards and depend on local prioritisation. The Directed Enhanced Services are compulsory but are for NHS Boards to commission.

Encouragingly participation in the directed enhanced services and the QOF, which have to be offered by the NHS Boards, has been very high among the GMS Practices in Scotland. Practices not on the GMS contract have also attempted to deliver services to at least the level of the GMS contract.

GP Practices are resourced to provide primary health care to all individuals registered with the practice, as appropriate, whether they have mental ill health, physical ill health or are generally in good health. Therefore anyone with a mental health condition should receive similar attention and monitoring to those with physical ill health, and for co-existing physical conditions identified through the appropriate registers.

The following synopsis, gives some indication of the way in which GP Practices are supported to provide care to people They include:

Essential Services

These require the management of patients who are ill or believe themselves to be ill, including health promotion advice and referral as appropriate, reflecting patient choice wherever possible. Health promotion advice includes advice regarding life style issues such as weight management diet, smoking cessation, regular physical activity and moderation in alcohol intake.

Additional services

These include: Cervical screening; Child Health Surveillance; Maternity services; and Contraceptive services.

Quality and Outcomes Framework of the General Medical Services contract,

Indicators include the development of a register and specified clinical management of patients with a number of conditions.

The following QOF indicators are particularly relevant to the published commitment on physical and mental health:

• Mental health - register of people with schizophrenia, bipolar disorder and other psychoses; annual review to include routine health promotion and prevention advice appropriate to their age, gender and health status; monitoring lithium therapy; comprehensive care plan agreed with patients and their family/carers recorded; active follow up by the practice team, within 14 days, of people who fail to attend;
• Dementia - register of people with dementia; annual review of care;
• Depression - annual review of patients with diabetes and/or Coronary Heart Disease to check for depression; patients with a new diagnosis of depression have an assessment of severity using a tool validated for use in primary care;
• Learning Disabilities - register of patients with learning disabilities;
• Obesity - register only of patients 16 years and over with a BMI equal to or over 30 in the previous year; and
• Smoking - smoking cessation in patients with coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, asthma, and schizophrenia, bipolar disorder and other psychoses.

There are additional service related indicators.

Enhanced Services

These are essential and additional services delivered to a higher specified standard or those services not provided through essential and additional services.

• Directed Enhanced Services - minor surgery; childhood and influenza immunisations.
• National Enhanced Services - specialised drug and alcohol misuse services; specialised depression services; specialised services for sexual health; minor injury services; enhanced care of the homeless; contraceptive fitting ( IUCD); specialised services of multiple sclerosis; and others.
• Scottish Enhanced Services Programme-NHS Boards can choose areas for development.