At age 55, Frankie has multiple health problems. Long-term mental illness has been managed with polypharmacy for many years. Clozapine therapy has contributed to weight gain, type 2 diabetes and profound constipation.

She has quit smoking but remains prone to chest infections and frequent hospitalisations. Her medications include five psychotropics, simvastatin, two antihypertensives, two inhalers, opiates for chronic pain and multiple laxatives.

Despite metformin and mixed rapid- and longer-acting insulin aspart 26 units mane and 22 units nocte, her diabetes is poorly controlled, with an HbA1c of 10% and usual blood glucose levels between 15mmol/L and 20mmol/L.

Frankie’s mobility is poor as a result of deconditioning and debilitating leg, back and abdominal pain. She sees her usual GP most weeks to manage her multiple comorbidities.