Jemimah is a medically qualified health economist, and a research fellow in the Health Economics Unit in the Centre for Health Policy at the University of Melbourne with an honorary position at the Murdoch Children’s Research Institute. Her research focuses on mental health care, and has included applications in perinatal mental health, serious mental illness, and children’s mental health. This seminar presents an NIHR-funded project on which Jemimah worked at the University of York with a team led by Professor Rowena Jacobs.
People with serious mental illness (SMI), a set of chronic conditions including schizophrenia and bipolar disorder, have high rates of physical and mental health comorbidities, high healthcare costs, and lower life expectancy than the general population. GPs in the UK provide much of the care for this group and are financially incentivised to provide certain types of care that are thought to improve care quality, but which lack a strong evidence base. We examined whether care plans, annual reviews of physical health, and relational continuity by GPs were associated with reduced use of hospital services (attendance at A&E and different types of admissions), specialist mental health care, and healthcare costs. We used administrative data from primary care linked to hospital and mental health services for a nationally representative sample of people with SMI in England. Using discrete time survival analysis, we found that all three GP activities were associated with reduced hospital use, while using two-part panel data models we found that care plans and physical health reviews were also associated with reduced costs across health sectors. These findings affirm that care plans and physical health reviews are valuable primary care activities that improve outcomes and reduce costs for this vulnerable group of patients, and support their inclusion in the incentives scheme. Relational continuity, which is not incentivised under the scheme, was also supported by these findings and may need to be prioritised given reductions in continuity due to changes in the delivery of primary care.