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A little extra work boosts income

Meeting mental health care standards can earn 41 points ­ Dr Charles Simenoff continues our series on the quality framework

ne of the new sources of income available to GPs through the quality and outcomes framework is mental health work. There are 41 points available for this.

As a percentage of the total 1,050 quality points, this is small, but mental health forms a large part of the average GP's workload and if the work is being done then it would be perverse not to do a small amount of extra work in order to obtain the quality payments on offer.

There are few indicators for mental

health that can be found in medical records and also few indicators that are suitable to encourage GPs to carry out tasks, unlike indicators used in the treatment of chronic physical diseases.

The 41 points are obtained by meeting the requirements of the following five categories.

1 Medical records

There are seven quality points available to the practice if it produces a register of people with severe long-term mental health problems who require and agree to having regular follow-up.

These conditions qualify:


lbipolar affective disorders

lunipolar affective disorders

lother psychoses (drug induced for example)


Patients should all be treated under a shared-care protocol and in the care of a secondary sector psychiatric unit, led by a consultant psychiatrist.

There is a legal obligation for the secondary care provider to sort out a package of care under a care programme approach (CPA). The GP should get regular CPA minutes which can be used for the practice's mental health register.

The practice will tell the PCO how many patients are on the mental health register and calculate the number as a proportion of the practice list size.

2 Ongoing management

This is worth 23 quality points.

GPs will have to show the percentage of patients with severe long-term mental health problems with a review recorded in the proceeding 15 months.

This review includes checks on the accuracy of prescribed medication, the patient's physical health and co-ordination with secondary care.

Patients with severe mental health problems are at an increased risk of physical ill-health due to poor diet, heavy smoking and a lack of exercise. Therefore it is now considered good practice for a practice team member, for example the practice nurse, to review each patient's physical health on an annual basis.

These patients may already be under review for a concurrent long-term problem, such as diabetes.

It is important to check the accuracy of medication because this may be changed by the secondary sector without informing the GP and the old medication then remains prescribed along with the new.

The annual check is also a good opportunity to review co-ordination arrangements with secondary care, especially CPN services and the voluntary sector. This should be recorded in the notes and/or on computer and summarised in a form readily accessible to all members of the primary care team.

3 Lithium therapy

A record of all patients' lithium levels over the last six months attracts three quality points.

4 Lithium therapy

A record of patients lithium levels within the therapeutic range in the last six months attracts five quality points.

5 Lithium therapy

A record of patients on lithium with a recorded serum creatinine and TSH levels in the last 15 months attracts three quality points.

Achieving mental health quality points will again involve the use of computers and we can expect revised READ codes to be available before April 1, 2004. For extra information on mental health quality standards it is worth accessing the new GMS contract supporting documentation.

A practical guide to the national service framework for mental health, by the National Primary Care Research and Development Centre, can be downloaded from

It would be perverse not to do a small amount of extra work to earn the payments ~

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