Table 1

Overview of QOF indicators for SMI used in the analyses

IndicatorDescriptionRationale
Care plan indicator [MH6]The percentage of patients on the register who have a comprehensive care plan documented in the records agreed between individuals, their family and/or carers as appropriateReflects good professional practice and is supported by national clinical guidelines. A care plan should be accurate, easily understood, reviewed as part of the annual review and discussed with the patient, their family and/or carers. It should cover:
  1. Current health status and social care needs, including how needs are to be met, by whom, and the patient's expectations

  2. How socially supported the individual is, eg, friendships/family contacts/voluntary sector organisation involvement

  3. Coordination arrangements with secondary care and/or mental health services and a summary of what services are actually being received

  4. Occupational status

  5. Early warning signs (relapse signature)

  6. The patient's preferred course of action (discussed when well) in the event of a clinical relapse, including who to contact and wishes around medication

Review indicator [MH9]The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses with a review recorded in the preceding 15 months. In the review there should be evidence that the patient has been offered routine health promotion and prevention advice appropriate to their age, gender and health statusPatients with serious mental health problems are at considerably higher risk of physical ill-health than the general population, but are less likely to be offered health promotion advice. The annual review should cover:
  1. Accuracy of prescribed medication

  2. Issues related to alcohol/drug use

  3. Smoking and blood pressure

  4. Cholesterol checks

  5. BMI

  6. Risk of diabetes from olanzapine and risperidone

  7. An enquiry about cough, sputum, and wheeze47

Lithium indicator 1 [MH4]The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 15 monthsLithium monitoring is essential due to the narrow therapeutic range (0.6–1.0 mmol/L) of serum lithium and the potential toxicity from intercurrent illness, declining renal function or co-prescription of drugs, eg, thiazide diuretics or NSAIDs which may reduce lithium excretion. It is therefore necessary to check calcium and thyroid function on a regular basis as well as renal function. There is a much higher than normal incidence of hypercalcaemia and hypothyroidism in patients on lithium, and of abnormal renal function tests. Overt hypothyroidism has been found in between 8% and 15% of people on lithium
Lithium indicator 2 [MH5]The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range within the previous 6 months
  • Sources: QOF guidance.23 ,47 ,48

  • BMI, body mass index; NSAID, non-steroidal anti-inflammatory drug; QOF, Quality and Outcomes Framework; SMI, serious mental illness; TSH, thyroid-stimulating hormone.