NHS Health Check Programme Research Articles

An evaluation of the performance of the NHS Health Check programme in identifying people at high risk of developing type 2 diabetes

ObjectiveTo evaluate the performance of the National Health Service (NHS) Health Check in identifying people at high risk of having or developing type 2 diabetes.DesignRetrospective evaluation of the performance of...

Understanding how the NHS Health Check works in practice

Aim: This qualitative study provides an insight into people's experiences of the NHS Health Check programme in practice. Method: A sample of ten participants took part in semi-structured interviews and were encouraged to talk about their experience of undergoing an NHS Health Check. Results: Two master themes emerged: understanding and awareness, and reassurance. Participants described a lack of understanding and awareness of both the existence and the purpose of the NHS Health Check. They had perceptions of the NHS Health Check as a ‘general health MOT’ and described their experience as a series of clinical tests, rather than an assessment of risk and lifestyle factors. A reassuring and confirmatory role of the NHS Health Check was highlighted with participants explaining how it had acted like a reassurance mechanism; and how they had attended their NHS Health Check appointment to confirm that they were in good health. Conclusions: The NHS Health Check is not being perceived by participants as a communication of risk of CVD, contrary to the key aim of this programme. Recommendations are made with reference to up skilling practitioners and making results meaningful.

12-month follow-up evaluation of the NHS Health Checks programme for Islington PCT: the community setting

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Cross-sectional review of the response and treatment uptake from the NHS Health Checks programme in Stoke on Trent.

BackgroundAs part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service.MethodsA cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes.ResultsOverall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%).ConclusionsThe attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation.

Preventing diabetes: will NICE guidance do what it says on the tin?

The goal of the programme was to achieve a 7% reduc-tion in body weight and physical activity of moderateintensity for at least 150 minutes per week. The cumula-tive incidence of diabetes was 4.8, 7.8 and 11.0 cases per100 person-years in the lifestyle, metformin and controlgroups, respectively. This reduction in incidence equatedto one case of diabetes prevented for every seven peoplewith IGT treated for three years in the lifestyle interven-tion group, compared with 14 for the metformin group. In addition, a review has also indicated that the numbersneeded to treat (NNT) to prevent one case of type 2 dia-betes with lifestyle intervention in people at risk of diabetesis dramatically low at 6.4 (over 1.8 to 4.6 years).

Prevalence of cardiovascular disease risk amongst the population eligible for the NHS Health Check Programme

The National Health Service (NHS) Health Check Programme aims to identify and manage patients in England aged 40-74 years with a 10-year cardiovascular disease (CVD) risk score over 20%. We aimed to assess the prevalence of high CVD risk in the English population, using the two CVD risk scores and the 20% cut off mandated in national policy, and the prevalence of risk factors within this population. Modelling study using patients registered in general practice in England. Using data from the Health Survey for England, we modelled the prevalence of high CVD risk in general practice populations. Of those eligible for an NHS Health Check, 10.5% (2,012,000) had a risk score greater than 20% using the QRISK2 risk score; 22.0% (4,267,000) using Joint British Societies' (JBS2) score. There was a median of 206 (range 0-1693) and 447 (0-3321) patients per practice at high risk respectively, with wide geographic variation. Within the high-risk population, there was a high prevalence of CVD risk factors; in the QRISK2 population, for example 82.6% were physically inactive. To reduce risk in those at high CVD risk, we estimate the total costs of the Programme to be £176 million using QRISK2 or £378 million using JBS2. A large number of high-risk patients will be identified by the Programme; health service commissioners must ensure the adequate provision and the targeted allocation of risk reduction services for the Programme to be effective. The NHS must consider whether extra costs using JBS2 are warranted. The Programme must be fully monitored to ensure its cost effectiveness and appropriate outcomes such as the numbers at high risk assessed.

Postcode lotteries in public health--the NHS Health Checks Programme in North West London.

BackgroundPostcode lotteries in health refer to differences in health care between different geographic areas. These have been previously associated with clinical services. However there has been little documentation of postcode lotteries relating to preventative health care services. This paper describes a postcode lottery effect in relation to the NHS Health Checks Programme (a national cardiovascular screening programme in England) in eight PCTs in the North West sector of London.MethodsA descriptive cross-sectional analysis of the Health Checks Programme was carried out in eight PCTs in North West London using a structured data-collecting instrument.ResultsThe analysis found variation in the implementation of the national Health Checks Programme in terms of: the screening approach taken; the allocated budget (which varied from £69,000 to £1.4 million per 100,000 eligible population); payment rates made to providers of Health Checks; tools used to identify and measure risk of cardiovascular disease and diabetes; monitoring and evaluation; and preventative services available following the health check.ConclusionsThis study identifies a postcode lottery effect related to a national public health programme. Although it is important to allow enough flexibility in the design of the Health Checks Programme so that it fits in with local factors, aspects of the programme may benefit from greater standardisation or stronger national guidance.

Delivering NHS health checks to all

The NHS Health Check programme (formerly known as vascular checks) is an ambitious initiative that will offer preventative checks to men and women aged 40–74 years to assess their risk of vascular disease (heart disease, stroke, diabetes and kidney disease). The Department of Health public health White Paper, Healthy Lives, Healthy People, published on 30 November 2010, confirmed that NHS health checks are here to stay. For primary care trusts, NHS health checks are already a reality. Work began in April 2009, with all primary care trusts expected to offer some checks in 2009/10 and full implementation required by 2012/13. By this time, 20% of eligible people should be invited for an NHS health check once a year, i.e. the whole population will be reviewed over 5 years. However, primary care trusts have a real challenge ahead to successfully implement the programme by 2012. Such challenges include: finding funding; deciding who will be responsible for commissioning the service; finding capacity for this service (and its required follow-up) and reaching certain populations. This article offers a novel model to address these changes.

Uptake of the NHS Health Checks programme in a deprived, culturally diverse setting: cross-sectional study

The UK is embarking on a national cardiovascular risk assessment programme called NHS Health Checks; in order to be effective, high and equitable uptake is paramount. A cross-sectional study, using data extracted from electronic medical records of persons aged 35-74 years estimated to be at a high risk of developing cardiovascular disease, to examine the uptake of the Health Checks using logistic regression and statin prescribing. A total of 44.8% of high risk patients invited for a Health Check attended. Uptake was lower among younger men but higher among patients from south Asian (AOR = 1.71 [1.29-2.27] compared with white) or mixed ethnic backgrounds (AOR = 2.42 [1.50-3.89]), and patients registered with smaller practices (AOR = 2.53 [1.09-5.84] <3000 patients compared with 3000-5999). The percentage of patients confirmed to be at high risk of CVD prescribed a statin increased from 24.7 to 44.8%. Uptake of cardiovascular risk assessment and prescribing of statins in high risk patients was considerably lower than projected in the first year of NHS Health Checks programme. Targeting efforts to increase uptake and adherence to interventions in high risk populations and reinvesting resources into population wide strategies to reduce obesity, smoking and salt intake may prove more cost-effective in reducing the burden of cardiovascular disease in the UK.

HCAs: vital contributors to the NHS Health Check programme

The NHS Health Check programme was introduced by the Department of Health in April 2009, in an attempt to make a significant impact on reducing the current burden attributed to cardiovascular disease morbidity and mortality across England. Although this is a nationally mandated programme, its delivery model is dependent on local commissioners and clinicians. This article describes an innovative approach taken in East and North Birmingham which uses cutting edge technology and is delivered by healthcare assistants (HCAs).

Assessing vascular risks: the NHS Health Check programme

The NHS Health Check programme (formerly known as ‘vascular checks’) offers preventative checks to all those aged between 40 and 74 to assess their risk of vascular disease, which includes kidney disease, followed by appropriate management and interventions. Here Ian Wilkinson outlines the programme.

Health checks: Could we be left with a hangover?

Alcohol misuse costs £2.7 billion a year to the NHS. Mark Holmes and Jamie Waterall ask whether the NHS Health Check programme has missed a chance to help reduce the health risks of alcohol misuse

Alcohol and the NHS Health Check programme: Could we be left with a hangover?

Alcohol misuse costs the NHS in the order of £2.7 billion per year; the total annual cost to the UK economy has been calculated at up to £25.1 billion. This article will examine if the Department of Health’s NHS Health Check programme policy launched in April 2009 has missed an important opportunity to contribute to tackling the growing health and economic burden of alcohol misuse. The authors believe that alcohol ‘identification and brief advice’ (IBA) should be a standard requirement for this programme. Consequently the article also provides a practical over view of the principles of IBA.