Poor physical health is common in people with Severe Mental Illness (SMI). Two-thirds of deaths in SMI could be avoided if patients are offered prompt physical health screening for known risk factors. We aimed to identify SMI patients registered at a General Practice and audit their care in relation to physical health monitoring. We included adult patients with coded diagnoses of SMI. We selected 18 best practice criteria for physical health monitoring, based on Quality and Outcomes Framework (QOF) indicators for mental health, NICE guidelines and other professional guidance. Data was obtained from electronic patient records and examined over a 12-month period. Only 5 out of 18 best practice criteria achieved compliance above the expected standard of 70% (annual record of blood pressure, smoking, alcohol, medication review, prescription on repeat template). Care planning achieved 69%; and most of the remaining parameters (pulse, BMI, weight, QRISK2, serum lipids, glucose, dietary advice, physical activity, drug use) reached levels around 50-60%. Particularly low compliance (<40%) was found for ECG, pregnancy/contraception advice and medication side-effects. There is definite room for improvement regarding physical health monitoring of SMI patients within general practice. We recommend increased attention to annual physical health checks, particularly cardiovascular risk factors, and the consistent offer of targeted interventions. Organisational financial incentives are also effective at increasing compliance results.