Physical health indicators in SMI

Abstract

Abbt and Alderson remark 'how little time we spend in general practice ... perhaps 8 weeks over an entire degree' but at Imperial College London and probably at most other medical schools, this represents greater time allotted than for many other specialties. We suggest the focus in medical schools should shift towards improving the quality of general practice placements and promoting the integration of primary care and specialist teaching, rather than consuming more time in an already overstretched curricula.We feel that prestige has never been the main incentive for pursuing a specialty. Our own experience is that many medical students are attracted to a career in general practice because of other factors, such as a good work-life balance, continuity of care and career flexibility. With many GPs now concerned about their workload, this inevitably influences students and junior doctors in their career choices.2 Another key factor is the funding that a specialty receives: recently, the proportion of the NHS budget spent on primary care has decreased and the income of GPs has fallen. To recruit more GPs, medical schools should improve the quality of students' experiences in their primary care placements. However by itself, this will not be sufficient to improve recruitment and the onus falls upon the NHS to once again make general practice a rewarding career for doctors. Physical health indicators in sMIWe are grateful to Mitchell and Hardy for highlighting their recent publication in Psychiatric Services. 1 We agree that we should have cited this paper in our article in the October BJGP, but we were unaware of it (possibly because it was published around the same time that we were preparing our manuscript for submission). For this omission we unreservedly apologise.However, we do not entirely agree that our UK-wide comparisons of QOF data were 'almost identical' to their work. Although there are obviously some similarities in these papers because both made use of the same publicly-available QOF databases, our paper is different in a number of important regards.Our analyses were cross-jurisdictional, with data from Scotland, Northern Ireland, Wales and England (Mitchell and Hardy considered only England). We specifically calculated population achievement rates, along with payment and exception rates, and reported differences in rates using a sign test, while Mitchell and Hardy calculated differences in achievement rates before and after exclusions only, using c 2 tests at a patient level. Mitchell and Hardy compared screening for BMI, blood pressure (BP), cholesterol and HbA1c/glucose between those with severe mental illness (SMI) and those with diabetes. We compared BMI in diabetes versus BMI in SMI, and also BP in chronic kidney disease versus BP in SMI. We agree wholeheartedly that we need new approaches to addressing health inequalities in SMI. Analysing routine data across the UK in coming years will remain very important.