To tackle health inequalities, ‘don’t just screen, intervene’

As a GP, I know that most patients affected by conditions such as schizophrenia and psychosis are cared for within primary care, by people like my colleagues and me. It is our responsibility to ensure we improve both mental and physical health care for these patients – and resources such as the updated Lester Tool can help us do so. In this blog I’d like to share with you how the tool can help make a real difference to the lives of some of our most vulnerable patients.

Data shows that people with severe mental illness (SMI) die up to 20 years younger than the general population, from preventable physical health conditions such as cardiovascular disease, diabetes, and cancer, and I have seen this first hand through my work as a GP This is why it was so important to me that NHS England’s approach to reducing health inequalities – Core20PLUS5 – included a focus on annual physical health checks for people living with SMI.

The NHS has made impressive strides in increasing the uptake of these physical health checks, particularly after the disruption caused by the Covid pandemic. And everyone involved in primary care and mental health services across the country should be proud of this achievement.

But the checks are only the first step. On their own, checks can’t improve health outcomes for people with SMI or address the longstanding inequalities in care – not unless they are accompanied by the right support and follow up interventions.

It was over ten years ago that the late Professor Helen Lester, another GP practicing in the Midlands like myself, was calling for the mantra ‘don’t just screen, intervene’ to be adopted. She argued that if we were to tackle the health inequalities people living with SMI are facing, we couldn’t just ask about people’s weight and smoking habits and then not act on that information. We needed to do more. We needed to explain about the side effects of antipsychotics and mood stabilising medications so people could make informed decisions. And we needed to discuss options with patients that would work for them when it came to avoiding weight gain or quitting smoking. This is still true today and this mantra needs to guide our work on improving the physical health of people living with SMI.

Prof Helen Lester worked on creating the first ‘Lester Tool’ back in 2012 to help frontline staff make assessments of cardiac and metabolic health of people living with SMI, and identify the best follow up interventions to look after their physical health.

Today, the Lester Tool has been updated with the latest NICE guidance, particularly given changes on assessing and managing cardiovascular risk, and with a greater emphasis on personalised care and support planning.

I hope this is the start of a genuine two-way conversation with people during their annual physical health checks, and that it encourages clinicians to consider what happens next after a physical health check. We need to have the same aspirations for quitting smoking or increasing physical activity for people living with SMI as for other patients, which is to work with people to explore medications and their side effects, discuss ways to improve physical health, and provide tailored support to keep them well. Together, we can make this change.

Dr Bola Owolabi

Professor Bola Owolabi (MRCGP, MFPH Hon, FRSPH) is Director of the National Healthcare Inequalities Improvement Programme at NHS England. She works as a General Practitioner in the Midlands.

Bola has particular interest in reducing healthcare inequalities through integrated care models, service transformation, and using data insights for quality improvement. She has spearheaded NHS England’s Core20PLUS5 approach to narrowing healthcare inequalities.

Internationally, Bola was a member of the Danish Ambassador’s Tour De Health – a ten nation healthcare policy leaders’ summit. Additionally, she was the UK representative on the Commonwealth Fund/Academy Health Tour 2023, exploring equity in national health policy across the United States, Australia, New Zealand and Singapore.

She was previously National Speciality Advisor for Older People and Integrated Person-Centred Care at NHS England, where she led the Anticipatory Care workstream of the National Ageing Well Programme. She collaborated with teams across NHS England and the Department of Health and Social Care as part of the Covid-19 pandemic response.

Bola is an alumna of Ashridge Executive Education/Hult International Business School and holds a Masters degree with distinction in Leadership (Quality Improvement). She also received an NHS Leadership Academy Award in Executive Healthcare Leadership for Clinicians.

Bola is an Honorary Professor at the Institute of Applied Health Research, College of Medicine and Dentistry, University of Birmingham. She is also a Vice President of the Royal Society of Public Health (RSPH).