Does better quality of primary care influence admissions and health outcomes for people with serious mental illness (SMI)? A linked patient-level analysis of the full patient care pathway

Serious mental illness (SMI) is a set of chronic enduring conditions associated with poor outcomes, high healthcare costs and high levels of disease burden. Life expectancy for people with schizophrenia and bipolar disorder is typically around 20 years less than for the general population and the majority of premature deaths in people with SMI are attributable to preventable causes. People with SMI are at higher risk of physical ill-health and hospitalisations. Primary care plays a central role in the provision of care for people with SMI, with around 31% treated solely by their general practitioner (GP).

‘Liberating the NHS’ outlined the Government’s focus on measuring health outcomes and NHS England has set out its aims for improving outcomes in line with the NHS Outcomes Framework with a strong emphasis on mental health. NHS England has exhorted general practice to play a central role in delivering better outcomes including preventing avoidable emergency hospital admissions and A&E attendances, improved access to primary care and prevention of premature mortality.

The study objective is to examine whether better quality of primary care for patients with serious mental illness can improve a broad range of outcomes (emergency admissions; A&E attendances; costs; morbidity; and mortality). The quality of care will be assessed with two sets of measures derived from primary care patient records: (i) those used in the Quality and Outcomes Framework (QOF) which cover SMI specific indicators; and (ii) other non-QOF measures