The Royal College of Psychiatrists has published Wim’s Protocol, a new practical guide to ensure the prescribing, and use of, antipsychotic medication clozapine remains safe for patients.
Concerns were raised during the inquest into the death of William ‘Wim’ Northcott, and following 2024 investigation by journalist Sean O’Neill at The Times working with Kate Northcott Spall, Wim’s sister, around the potential risks associated with clozapine. The College met with Kate, and started to take action to ensure improvements and consistency in the way that the medication is prescribed and monitored, so that it is used in the safest and most effective ways possible.
Wim, who had schizophrenia, was repeatedly unwell and died of a cardiac arrest in July 2021. He had been taking clozapine, alongside other medications and alcohol, and his physical health and potential interactions should have been very carefully monitored and any issues acted on. This didn’t happen the way it should have done.
Clozapine is an incredibly effective treatment for patients with treatment-resistant schizophrenia. Proper use of this medication is associated with improved mental health outcomes, but also improved mortality rates in people with severe mental illnesses like schizophrenia. Yet people on this medication need very close monitoring. Sadly, avoidable deaths continue to occur and Wim’s Protocol aims to address this.
This practical guide was developed in collaboration with William Northcott’s sister, Kate Northcott Spall; and in consultation with Nichola Crawford, whose brother-in-law also sadly died while taking clozapine; medical organisations; pharmacists; NHS services; and regulatory bodies.
Wim’s Protocol aims to help healthcare professionals prescribe clozapine safely, apply the appropriate monitoring for patients who are on it, make sure people who need it can access it quicker and reduce the risk of serious side effects. It provides evidence-based guidance for physical health monitoring at all stages of treatment, with a focus on supporting all healthcare professionals to deliver appropriate physical monitoring and interventions as necessary, whatever healthcare setting a person presents to.
The guide also recognises that many people play an important role in supporting people taking clozapine and aims to help family, friends, support workers, and others in the community to monitor and recognise concerning symptoms early on and encourage them to seek help. We hope this protocol will save lives.
Kate Northcott Spall said:
“I am overwhelmed and delighted to announce the launch of Wim’s Protocol today. This is a vital new safety regime and monitoring for clozapine patients.
“When Wim died on July 13 2021 I made a promise he would have a long-lasting, positive legacy, one that ensured no other patient would die due to clozapine monitoring failures like Wim.
“Wim’s Protocol is that promise made good. A culmination of five years of anger, grief, hard work and hope.
“It has been a privilege to work with Lade and Ed these past couple of years. It is thanks to their open minds and ability to face difficult questions that we found an answer in Wim’s Protocol. I am forever grateful to them.
“The launch of Wim’s Protocol marks the end of a very personal journey for me of grieving for Wim. I can finally let go of him and watch from the sidelines as his legacy saves the lives of his peers. Wim would love that.”
Dr Lade Smith CBE, President of the Royal College of Psychiatrists, said:
“Wim (William) Northcott’s death was a terrible tragedy, and my deepest sympathies are with his sister Kate and their family, and also with others who have lost a loved one in this way.
“When Wim died, he was taking clozapine, a medication that can be life-changing for people with treatment-resistant schizophrenia. Yet, Wim’s death highlighted the devastating consequences that can occur when serious adverse effects or interactions are not detected early enough.
“Wim’s sister, Kate Northcott Spall, and our Presidential Lead for Physical Health, Dr Ed Beveridge have worked tirelessly during the past two years, alongside others, to put together Wim’s Protocol.
“I’m delighted to see this crucial guide finally published after almost two years of careful consultation and analysis.
“The College looks forward to encouraging mental health clinicians and other healthcare professionals to take up the protocol, as well as promoting it more widely. This will mean all those who require clozapine can access it safely, be provided with the right support and live the long healthy lives they deserve.”
Dr Ed Beverage, RCPsych Presidential Lead for Physical Health said:
“Clozapine is a very effective medication and is life-changing – often life-saving – for some patients. Yet, like any medicine, it has side effects and can cause serious illness, or even avoidable deaths, if they are not identified and treated.
“We became aware of a number of cases, including Wim’s, where deaths had occurred from avoidable physical illness in people taking clozapine. While there is a lot of guidance around physical health investigations and monitoring for people taking it, there is currently no single agreed protocol used across the UK.
“We created Wim's Protocol to fill this gap. It is designed to give healthcare professionals a clear, practical guide on how to prevent, detect and manage the potentially serious side effects associated with taking clozapine.
“It will also support patients and their families to understand what symptoms to look out for and how to get help if they occur. Over time, we want patients, carers and professionals to become confident in having conversations around the effects and interactions of clozapine. This will mean everyone who needs the medication should be able to receive it.”
If someone is concerned and thinks they may want to reduce, or stop taking antipsychotic medication, they should always seek the advice and support of their doctor first.
Read the guidance: Wim's Protocol – for the safe prescribing and monitoring of clozapine
Related resources
Clozapine for treatment-resistant schizophrenia – Clozapine for treatment-resistant schizophrenia: The case for timely and appropriate use. Position Statement PS01/26, January 2026
Clozapine is used in the treatment of the following conditions:
Wim’s Protocol: for the safe prescribing and monitoring of clozapine
For further information, please contact:
- Email: press@rcpsych.ac.uk
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