BACKGROUND: People with severe mental illness (SMI) have a higher risk of developing cardiovascular disease (CVD) compared with the general population. Clinical guidelines recommend annual screening for CVD risk factors with appropriate lifestyle counselling. Aims To establish the proportion of patients with SMI being screened for CVD risk factors in their primary care practice compared with those with diabetes and determine whether people with SMI receive lifestyle advice. METHOD DESIGN: a retrospective audit. SETTING: five primary care centres in Northampton, England. PARTICIPANTS: three hundred and eighty-six patients with SMI and 1875 with diabetes. RESULTS: Just over a fifth of patients with SMI received a full CVD screen compared with the 96% of those with diabetes (OR = 90.37; 95% CI = 64.53-126.55, p < 0.01). Fifty-seven per cent of the SMI patients were given smoking advice but only 13% and 14% received guidance regarding diet and exercise, respectively. On average of each patient with SMI received fewer than two (from four) screening interventions and less than one (from three) components of lifestyle advice. CONCLUSIONS: In primary care, the number of people with SMI receiving screening for CVD risk is much lower than those with diabetes.