SMI Comprehensive Physical Health Checks (PHSMI) GPES Extract

NHS England wish to continue to use the Physical Health Checks for people with Severe Mental Illness (PHSMI) data which was collected via the General Practice Extraction Service (GPES) in order to monitor the delivery of the NHS Long Term Plan ambition to ensure that 390 thousand people with Severe Mental Illness (SMI) have their physical health needs met by receiving a comprehensive physical health check (PHSMI) and follow-up intervention. The previous version of the Agreement required an initial full year extract of the data and thereafter an extract on a quarterly basis to monitor delivery of the PHSMI programme

No further data is required in this agreement other than extension to the Data Sharing Agreement to enable NHS England to continue to use the PHSMI data in order to monitor the delivery of health checks and interventions for people with SMI over the lifetime of the NHS Long Term Plan.

The lawful basis for processing personal data are Articles 6.1(e) “where processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller” and 9.2(j) “where the processing of personal data is necessary for archiving purposes, scientific or historical research purposes or statistical purposes in the public interest”.

The aim of the extract is to track delivery of PHSMI and reduce the levels of premature mortality for people living with severe mental illness by increasing early detection and expanding access to evidence-based physical care assessment and intervention each year

This data is anticipated tol help clinicians understand how well they are performing in the diagnosis and management of six elements of the PHSMI. The extract will consist of routinely recorded GP data covering alcohol consumption, blood lipids, blood glucose, smoking, BMI and blood pressure. In summary, the extraction is needed because the data is anticipated to:

• help monitor health outcomes to understand whether delivery of physical health checks and follow-up interventions lead to improvements in physical health indicators in people with SMI over time, including whether any given patient retains improvements in subsequent annual health check cycles

• inform whether current policy and practice exacerbate or reduce health inequalities, including an insight into which patient cohorts are accessing health checks and interventions, and whether these have the same impact in different cohorts

• review whether different risk factors (for example SMI diagnosis, demographics, socioeconomic status, or frequency of contacts with primary and secondary care) can be utilised to inform risk stratification of physical health checks and determine the style or frequency of checks appropriate for various patient cohorts

• assess and address local inequalities in access to and uptake of physical health checks and interventions, informing a targeted approach to improve service provision on national and local levels

• help understand the impact of health checks on healthcare utilisation and the subsequent cost effectiveness of delivery.

The data collection links to ICS's’ Statutory functions, responsibilities and commitments to, alongside other bodies, improve and integrate services providing physical healthcare, reduce health inequalities and reduce premature mortality across people with SMI, in line with the relevant legislation including the Public Sector Equality Duty, the Equality Act 2010, and the Health and Social Care Act 2012.

Data outputs from the audit will be targeted for use by health care economies including practices, primary care networks and ICSs. Information will also be generated to inform national policy and improvement work.

Outputs will show variation in diagnosis and treatment across areas, provide new information on the occurrence and co- existence of co-morbidities and allow for the assessment of characteristics of those receiving health checks (including age, ethnicity and deprivation). The adoption of the business rule set for PHSMI at individual practice level will facilitate detailed case finding and quality improvement work within practices.

In the previous Agreement, Personal and special category data was collected from all participating GP Practices in England, with an initial full-year extract of data and thereafter an extract on a quarterly basis, was disseminated.

GP IT System Suppliers extracted data already held in GP Practice patient record systems and transferred this data to NHS Digital using the established General Practice Extraction Service (GPES) tool.

No further data will be disseminated in this Agreement.

NHS Digital has been directed by NHS England under section 254 of the Health and Social Care Act 2012 (2012 Act) to establish and operate a system for the collection and analysis of the information specified for this service.

All GP Practices in England are legally required to share data with NHS Digital for this purpose under section 259(1)(a) and

(5) of the 2012 Act.

The legal basis for the transfer of data is given in the 'SMI Physical Health Checks Directions 2020' signed on 13th October 2020 which includes section 259(1)(a) of the Health and Social Care Act 2012 (the 2012 Act), a Data Provision Notice will be served in accordance with the procedure published as part of the NHS Digital duty under section 259(8) on the following persons:

• General Practices in England, covering the four core GP system suppliers (GPSS):

o TPP

o EMIS

o Cegedim Health Solutions

o Eva Health Technologies

Once the data is collected from GPSS, validation on the file structure and contents is carried out before files are accepted by NHS Digital’s GP Data Collector system. The data is then processed by the Data Management Service (DMS) to create a data asset. The processing involves loading the files from GPSS into a secure database and linking to corporate reference data to provide additional demographic information. The data is stored separately and only the pseudonymised view is made available to people. Data quality will be checked against the standard six data quality characteristics, which are coverage, completeness, validity, default, integrity and timeliness, as per the requirements of NHSE/I.

Many of the SNOMED CT codes used to specify the data items listed are also used in the Quality and Outcomes and Framework (QOF) and other payment extractions and therefore the data quality of these codes is expected to be high. For other SNOMED CT codes that are not used in payment extractions, the data quality may not be as high. Analysis conducted by NHSE/I will determine this. Other non-coded information will be validated against standard NHS Digital protocols. For example: patient NHS Number will be validated against the Modulus 11 algorithm and GP practice code will be validated against reference data held by NHS Digital.

Under section 259(5) of the 2012 Act, the organisation types specified in the above Scope must comply with the Form, Manner and Period of the data collection requirements.

In line with the national data opt-out operational policy guidance, national data opt-outs will not apply to the collection. However, Type 1 objections will be upheld in collecting this data from General Practices and therefore the data for those patients who have registered a Type 1 objection with their GP will not be collected. The Type 1 objection prevents an individual’s personal identifiable confidential information from being shared outside of their GP Practice except when it is being used for the purposes of their direct care.

Data flow and access: NHS Digital to NHSE, in summary:

a) NHS Digital sent pseudonymised data to NHSE via Message Exchange for Social Care and Health (MESH)

b) Data will not be stored or processed by a third party. Data will be stored in a secure NHS England network folder with named access to only a small number of analysts.

Data processing will only be carried out by substantive employees of NHSE who have been appropriately trained in data protection and confidentiality (as required in mandatory training for all NHSE employees).

Data Requirement

All fields in the dataset are required so that NHSE can provide analytical support to the ongoing monitoring of the

PHSMI programme. This would not be possible without the full amount of data. PHSMI GPES is a national collection so national data is required in order to assess geographical trends and identify any geographical and demographic variation in PHSMI.

Data Analysis

The data will be used to create indicators which can be used to describe, measure and summarise. This information will be reported at different geographies and by different descriptors to show variation and identify opportunities for improvement in care and outcomes. Data will be published only in aggregate form with small numbers suppressed in line with the HES analysis guide to ensure that no individual can be identified in any output. Information will be released in different formats for different audiences and will include written reports, slide sets, dashboards and briefings/infographics.

There will be no attempts made to re-identify individuals involved in this project as there is no requirement to do so.

The data will not be made available to any third parties except in the form of aggregated outputs with small numbers suppressed in line with the HES Analysis Guide. There will be no requirement nor attempt to re-identify individuals from the data.

Reports will be produced periodically throughout 2022/23 and will focus on national data. Information will also be released at lower geographies which will show variation between Regions and ICSs, data will be released at both PCN and practice level from 2023/24 following an assessment of the robustness of the data at these levels. The format for this has yet to be finalised but will ultimately form a dashboard.

All outputs will be anonymous and will not report on individual patients and no output will contain any personal identifiable data. Data will be published only in aggregate form with small numbers suppressed in line with the HES analysis guide to ensure that no individual can be identified in any output. Information will be released in different formats for different audiences and will include written reports, slide sets, dashboards and briefings/infographics.

Specifically:

- An Interactive dashboard: including national and localised findings. Localised findings will be available at different healthcare geographies.

Outputs from the data collection will be designed to inform a number of different audiences, including but not limited to:

- Providers of primary care;

- Commissioners;

- Policy makers in government and NHS England;

The NHS Long Term Plan has identified physical health checks for patients with severe mental illness as a priority, with the potential to prevent premature mortality of up to 15-20 years

Routine data collection is the essential starting point for this ambition. Without real time data, the health system will have no indication of the scale of the problem or the opportunity for improvement for patients and populations. It is the only way to systematically identify individuals whose high-risk conditions are sub-optimally managed, either through non-diagnosis, under treatment or over treatment. NICE have produced guidance on improving the physical health for people with serious mental illness (https://www.nice.org.uk/sharedlearning/improving-physical-health-for-people-with-serious-mental-illness-smi ) Data will help to focus and optimise the programme locally and nationally. This data will allow the provision of comprehensive locally specific and nationwide information related to PHSMI and associated interventions. This will help to highlight opportunities for broader professionally led quality improvement activity associated with the delivery of the NHS Long Term Plan.

In summary, the extraction is needed because the data from the audit will support:

• The monitoring and evaluation of national access targets from the NHS Long Term Plan

• Local quality improvement activity

• Measurement of the impact on population outcomes

This data will provide information on a national and local level that has not previously been available. The extract will allow analysis of primary care data beyond that currently published as part of the Quality and Outcomes Framework enabling the reporting of familiar indicators but with greater detail which will be available to inform improvements in service delivery and to reduce inequalities. For example, the extract will include data and information around SMI health checks broken down by age group which will enable Primary Care Networks to be able to optimise care. Other novel analyses will include a review of the extent to which comorbidities occur within the SMI population.

This data will support health systems (Mental Health Services, ICBs and GPs) to measure the levels of health check delivery for people with SMI and help them implement strategies to increase this number and provide follow up interventions to address the key causes of premature mortality (currently 15 – 20 years earlier than the general population) for people with SMI from preventable diseases. The ambition is to increase delivery of health checks to 390K by 2023/24, there is significant effort required to achieve this number from our starting point of 150K in 2019/20. Increasing health checks to a greater number of people, will help to screen them for potential life threatening conditions and provide interventions to extend their lives.