Mental health (MH) - QOF indicator

Mental health in QOF 2026/27

The mental health (MH) indicators cover care planning and physical health monitoring for people with schizophrenia, bipolar affective disorder and other psychoses. Notable requirements for 2026/27 include lipid testing at different intervals according to risk, and the exclusion of patients with diabetes from MH012.

Ongoing management indicators

Why mental health is included

• General practice encounters mental health difficulties alongside interrelated physical, psychological and social needs. The indicators recognise this complexity.

• For many patients, the quality of care depends particularly on how their doctor communicates, how much consultation time is available and whether they can explore different approaches to management.

• Reducing physical health inequalities is a central purpose of the indicators. People with severe mental illness (SMI) have a life expectancy around 15-20 years shorter than others, largely because of physical illnesses that could be prevented. Chronic conditions occur earlier in this group, including obesity, asthma, diabetes, chronic obstructive pulmonary disease, coronary heart disease, stroke, heart failure and liver disease. Having several of these conditions is also more likely.

Physical health checks recommended by NICE

For adults with psychosis or schizophrenia, NICE CG178 advises primary care to use registers to support physical health monitoring. Reviews should be broad in scope, with particular attention to physical conditions frequently seen in these patients. Recommended components are:

• Charting weight measurements.

• Measuring the waist.

• Checking pulse alongside blood pressure.

• Testing fasting blood glucose or glycosylated haemoglobin (HbA1c).

• Measuring blood lipids and prolactin.

• Looking for movement disorders.

• Reviewing nutrition, dietary intake and physical activity.

For bipolar affective disorder, NICE CG185 advises a physical health review at least annually, usually undertaken in primary care. This should cover:

• Weight or body mass index (BMI), together with diet, nutrition and physical activity.

• Cardiovascular assessment, including pulse and blood pressure measurements.

• Metabolic assessment, including glycosylated haemoglobin (HbA1c) and a blood lipid profile.

• Assessment of liver function.

• Checks of renal function, thyroid function and calcium for patients receiving long-term lithium.

Cardiovascular and diabetes risk

The annual SMI check has a particular role in finding risk factors, including metabolic syndrome, for cardiovascular disease (CVD) and type 2 diabetes. These conditions occur 2-3x more often than in the general population and account for much of the difference in life expectancy.

Obesity, hypertension and abnormalities of glucose and lipids can occur together through the combined metabolic effects of psychotropic medicines and behaviours such as an unhealthy diet and limited physical activity. Smoking rates are also substantially higher than in the wider population, adding to the risk. A comprehensive annual review, coupled with support to access suitable interventions, is therefore important in reducing that risk.

Further information and tools

• NICE CG178 (2014) provides guidance on adult psychosis and schizophrenia.

• The Lester tool offers a template that practices can use for physical health reviews in mental health care.

MH002: care planning

Rationale

MH002 draws on NICE IND143. It represents good professional practice and has support from the NICE guidance on adult psychosis and schizophrenia (CG178) and bipolar disorder (CG185).

• For patients included on the mental health disease register, the record should show a primary care consultation that addresses their care plan, particularly following relapse. The perspectives of relatives or carers should be considered when appropriate.

• After discharge from secondary care, responsibility falls to the primary care team to discuss the plan and enter it in the primary care record.

• A plan documented by community mental health services can count for QOF if the practice holds evidence that it has been reviewed.

• When a patient relapses after a recorded period of remission, the plan needs updating after that relapse. A plan that predates the relapse cannot meet the QOF requirement.

Reporting and verification

• The indicator definition sets out the criteria that must be met.

• Commissioners may ask contractors to provide a randomly chosen selection of care plans so that annual review and any necessary revisions can be checked.

MH003, MH006, MH007, M011 and MH012: physical health monitoring

These indicators draw respectively on NICE IND84, IND83, IND82, IND158 and IND159.

Rationale

NICE CG178 and CG185 advise annual blood pressure monitoring for people with bipolar disorder, psychosis or schizophrenia. A prospective record-linkage study following mortality in a community cohort of 370 people with schizophrenia suggested that excess mortality probably persists throughout life. It also suggested that, compared with the general population, cardiovascular mortality in schizophrenia had risen over the past 25 years. The NICE bipolar disorder guideline reports that the standardised mortality ratio for cardiovascular death may be twice that in the general population, although adherence to long-term medication appears to lower it.

In the wider population, impaired glucose tolerance, diabetes, hypertension and dyslipidaemia generally appear around middle age. In SMI, these abnormalities may already be identifiable at first presentation. This partly accounts for the underestimation of risk in young people with SMI by cardiovascular prediction tools designed mainly for the general population. Documenting cardiovascular risk factors, as well as treating them, is consequently particularly important for this group.

MH007 rewards recording alcohol intake during the physical health check. There is growing recognition of alcohol and other substance misuse in schizophrenia as a substantial concern because of both how common it is and its clinical and social consequences. In England's National Psychiatric Morbidity Survey, 16% of people with schizophrenia reported drinking above the lower-risk level of 14 units. Alcohol and other substance abuse also commonly coexist with bipolar affective disorder.

Annual blood glucose or HbA1c monitoring for people with bipolar disorder, psychosis or schizophrenia is recommended by NICE CG178 and CG185. Diabetes occurs 2–3 times more often in SMI than in the general population, and antipsychotics can cause diabetes. Type 2 diabetes also tends to develop earlier in people with SMI, often during the fourth and fifth decades.

Reporting and verification

• Refer to the indicator definitions for the qualifying requirements.

• The business rules apply the following definitions:

• Current antipsychotic treatment requires a prescription in the preceding 6 months.

• The pre-existing cardiovascular conditions counted are CHD, diabetes, stroke, peripheral arterial disease and chronic kidney disease.

• Classification as a current smoker uses the smoking status entered in the notes in the preceding 12 months.

• Overweight is determined from the latest BMI: ≥ 23 kg/m2, or ≥25 kg/m2 when ethnicity is recorded as white.

• A diagnosis of diabetes excludes the patient from MH012.