The must-read stories and debate in health policy and leadership.

Commissioners in City and Hackney have warned national policy makers they need to find a mechanism to ensure that people who are prescribed long-term antipsychotics have regular health checks and medication reviews in primary care.

Under the current “quality and outcomes framework” – GPs’ pay for performance system – they are only paid to review those who are on the serious mental illness register. This relies on them having a diagnosis of bipolar, schizophrenia or psychosis.

The problem here – and the hole in current policy – is antipsychotics can be prescribed for the management of a whole host of other mental health conditions.

The upshot is that the long list of associated health risks with these serious medicines, such as diabetes and obesity, may be missed and left unaddressed.

Within City and Hackney alone – which is relatively low down the antipsychotic prescribing table – there were 1,200 patients taking long-term antipsychotics without a serious mental illness diagnosis.

Extrapolate this to the rest of the England population, and you may have a pretty large number of people on antipsychotics whose health is at risk of deteriorating, with no review.

Expanding QOF out to everyone who has been prescribed with antipsychotics seems a rather unlikely solution at the minute; but could the issue be addressed through the developing primary care network contract? 

That too would be difficult in the short term, given the recent fury from general practice over the increased workload proposed in the 2020-21 PCN contract asks. 

In the meantime, more commissioners and GPs getting their head around this problem in their area, perhaps with a similar data exercise, would at least be a start and give a baseline for the future.

Rattling some big tins

Two NHS trusts have targeted raising £100m from public donations to help finance the construction of a specialist children’s hospital in what is understood to be the biggest health service fundraising operation of its kind, as we revealed yesterday.

Cambridge University Hospitals Foundation Trust’s chief operating officer Nicola Ayton said while it was a large sum, the trust and its partners were confident of delivering it with partners Cambridge and Peterborough FT, and the University of Cambridge, which is an experienced fundraiser.

CUH has already secured £100m of government funding, while CPFT will contribute £20m from a land sale. The partners, however, estimate the project will cost around £220m, so are looking to raise the remaining £100m via donations from philanthropic organisations, major donors and contributions from the wider general public.

The East of England is the only region in England without a dedicated specialist children’s hospital and CUH remains confident it can achieve the ambitious target, in part by leveraging the university’s fundraising skills.

Experts at think tank New Philanthropy Capital did, however, warn the proposal was a “bold challenge, perhaps record breaking”.

It would be wrong to draw a direct line between the squeezing of capital budgets over the last decade and the emergence of a trust looking to raise such a large amount through public donations.

But, equally, it would be wrong to not consider the issue as a factor.

Significant real-term cuts to the NHS’ capital budget over the last decade mean the UK now spends “about half the share of GDP on capital in healthcare compared with similar countries”, the Health Foundation said.

News of this proposal further shows how crucial it is that the NHS strikes a realistic long-term capital deal with ministers over the coming months to sit alongside the revenue deal agreed to support the NHS long-term plan. Negotiations around a capital deal remain ongoing.