Evaluation of the uptake and delivery of the NHS Health Check programme in England, using primary care data from 9.5 million people: a cross-sectional study

Riyaz Patel,John Robson,Emma Clegg,Catherine Lagord,Sharmani Barnard,Katherine Thompson,Robert Worrall,Nilesh J Samani,Michaela Nuttall,Matt Kearney,Julian Flowers,John Deanfield,Jamie Waterall,Slade Carter,Tim Evans,Dave Roberts

doi:10.1136/bmjopen-2020-042963

Abstract

ObjectivesTo describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England.DesignObservational study.SettingNational primary care data extracted directly by NHS Digital from 90% of general...

Highlights

Cardiovascular disease (CVD) remains a major public health priority in England.[1]
In the largest nationwide study of the National Health Service (NHS) Health Check programme, using primary care data, we find that the checks have been offered to over 9.5 million people during a 5-year cycle up to 2017, with 52% of people taking up the offer
Where an National Health Service Health Check (NHSHC) was delivered, risk factors were identified at a similar rate to population estimates, with advice and referrals offered over 2.5 million times to those with risk factors, along with 20% of those at highest risk receiving a new statin prescription as per guidelines

Summary

Introduction

Cardiovascular disease (CVD) remains a major public health priority in England.[1]. To address this, the government introduced an ambitious programme of vascular checks in 2009, for people aged 40–74, delivered by England’s National Health Service (NHS).[2]. Modelling suggesting that each year NHSHCs would prevent 9500 heart attacks and strokes, 4000 new cases of diabetes and identify at least 25 000 people with existing undiagnosed diabetes or kidney disease before they developed complications.[2 4] with the same vascular risk factors increasingly recognised as contributing to other conditions like dementia, preventable cancers and liver disease,[3] the programme has assumed an even greater importance in the prevention of non-communicable diseases (NCD).[5,6,7]. Since 2013, following legislation, local authorities have a statutory obligation to make provision for all eligible people to have an NHSHC every 5 years.[8] concerns have been raised that delivery and practical implementation of such a programme presents a paradoxical risk of increasing health inequality if implemented in a way which does not systematically prioritise equity of access, outputs and outcomes. The absence of convincing randomised clinical trial evidence about the effectiveness of such programmes has further prompted ongoing scrutiny and questions around its delivery, uptake, impact and cost-effectiveness.[9]

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Conclusion