Introduction: Identification and prevention of cardiovascular disease (CVD) was identified as the single biggest area where the NHS can save lives in the NHS Long-term plan [1]. The NHS Health Check screening aims to assess a person’s risk of developing CVD, type 2 diabetes and dementia and offer advice to help people maintain or improve their health [2]. Student-led health check clinics have been implemented in other universities, proving to be a viable mechanism to deliver Experiential Learning, while providing health services to an underserved population [3]. A robust training programme was required, ensuring students to develop skills whilst also demonstrating competence to deliver the service. Methods: A bespoke training package was collaboratively designed by practitioners, simulation faculty and practice partners to support skill development and demonstration of competence. Alongside a programme of traditional teaching (incorporating clinical and consultation skills) and mandatory training, two half-day in-person simulation sessions were used to consolidate learning and allow for exploration of key concepts prior to launch of the service. In the first of these two sessions, an AI-enabled manikin was utilised to allow students a safe opportunity to undertake a full protocol-based CVD screening assessment. In the second session, standardised patient actors were used to provide students an opportunity to combine both clinical and consultation skills. Following the simulated events, assessment of student competence was conducted. Using standardised patients in a controlled environment, students were tested against a nested Entrustable Professional Activity (EPA), encompassing key components of the health check. Results: All 153 students passed the competency assessment following the training. A University-based health check service for staff and students led by pharmacy students under supervision by qualified practitioners was subsequently launched. Student-led CVD screening in the community will commence from the 25–26 academic year, in collaboration with a local primary care network. Evaluation is ongoing, focussing on student views of the training. Initial responses suggest the simulated placements were well situated in terms of wider taught content and that, following completion of the training programme, students felt able to safely perform an NHS Health Check. Discussion: Development and implementation of a comprehensive training package, incorporating traditional and simulated learning methodologies, has successfully facilitated the establishment of a student-led health check service within the University. Student performance and initial student feedback regarding their perceived competence to safely perform the service highlights the effectiveness of this approach in preparing future pharmacists for expanded roles in preventative healthcare. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Menopause to be included in routine NHS health checks in England.

Abstract Background The NHS Health Check programme was introduced in the UK in 2009 to prevent cardiovascular disease and related conditions. Despite its widespread implementation, concerns persist regarding its long-term clinical effectiveness, with existing studies often relying on surrogate outcomes, short follow-up periods, or non-representative populations. This study aims to determine whether participation in the NHS Health Check programme is associated with a long-term survival benefit. Methods This retrospective cohort study, adhering to STROBE guidelines, used anonymised primary care electronic health records from Lambeth (2009 to 2023). We identified 157,917 individuals eligible for an NHS Health Check, of whom 42,420 attended at least one Health Check and 115,497 did not. Follow-up began at eligibility and ended at death, study close, or administrative censoring. We employed a time-varying Cox proportional hazards model with propensity score weighting to adjust for confounding factors, including sociodemographic variables, behavioural risk factors, and family history. Results Among this ethnically diverse cohort (over 40% non-white), attending at least one NHS Health Check was associated with a significantly lower risk of all-cause mortality (adjusted hazard ratio [AHR] 0.68, 95% CI: 0.60 to 0.73). The absolute risk of death at 10 years was stratified by age, with the most notable reduction observed in individuals over 65 years, where risk decreased from 14.1% to 9.6%. Sensitivity analyses confirmed the robustness of these findings. Conclusions This is the first large-scale study to demonstrate a significant long-term survival benefit of the NHS Health Check programme using real-world, representative data. These findings support the continued investment in and optimisation of the programme to provide population health benefits. Further research should explore differential benefits across population subgroups to inform more equitable delivery. Key messages • NHS Health Checks are associated with a one third reduction in risk of death in diverse London population. • The biggest absolute risk reductions from NHS Health Checks were seen in people aged 65 years and over, highlighting their value in older age groups.

Cardiovascular disease (CVD) is the leading cause of death globally; in the UK it contributes to a quarter of all deaths. In 2009, the UK National Health Service launched the NHS Health Check (NHSHC) programme to address CVD by assessing all adults aged between 40 and 74 years for CVD risk factors. Encouraging uptake of NHSHCs has proved challenging and areas for development have been identified nationally, prompting modifications to NHSHC practice in some localities. This protocol article describes a programme of research that will evaluate the impact of NHSHC modifications on attendance and outcomes in a large English local authority area. Modifications to NHSHC delivery (delivery of a modified NHSHC by a healthy lifestyle service rather than via general practice led delivery) and NHSHC invitation processes (implementation of text message prompts and reminders and an additional online booking option) will be evaluated. The research consists of six workstreams within a mixed methods framework: 1) Quantitative analysis of client NHSHCs records; 2) Focus groups with healthy lifestyle staff involved in coordinating and delivering the modified NHSHCs sessions; 3) Interviews with staff from pilot GP practices whose roles involve the coordination or delivery of NHSHCs; 4) Interviews with clients who have attended a healthy lifestyle service NHSHC; 5) Health economic resource and cost evaluation; 6) Data analysis, synthesis, and dissemination. The research programme’s breadth and its novel nature, mean that it will provide valuable findings for those commissioning and delivering NHSHCs nationally, and for the wider public health community.

Abstract Background Cardiovascular disease (CVD) prevention is a key focus of the UK Government due to widening health inequalities and rising preventable premature deaths. Population-wide interventions, such as the NHS Health Check programme, aim to promote early detection and primary prevention of CVD. Introduced in 2009, NHS Health Checks became a statutory responsibility for UK Local Authorities, requiring them to invite eligible individuals to the programme every five years. While evaluations of the programme demonstrate improvements in CVD detection and surrogate markers, evidence on its impact on long-term outcomes remains limited. Aim To evaluate the effectiveness of NHS Health Checks in reducing premature mortality across an inner-city Local Authority with a diverse population. Methods A retrospective cohort analysis was conducted using primary care records from 99,600 participants eligible for NHS Health Checks between 2009 and 2023. Participants were divided into those who attended at least one Health Check (n = 18,259) and those who did not (n = 81,341). Survival analysis was performed using a Cox proportional hazards model with time-varying exposure to assess the risk of premature mortality between the groups. The model adjusted for confounding variables such as age, sex, geography, sociodemographic factors, and behavioural risk factors, using propensity score weighting. Subgroup analyses explored differences by deprivation quintile and ethnicity. Results Time-stratified Cox analysis revealed an adjusted hazard ratio (AHR) of 0.33 (95% CI: 0.17–0.64) in the final follow-up period (10–15 years), indicating a 67% lower risk of premature mortality among those who attended at least one health check. Sensitivity analyses supported these findings. Conclusions NHS Health Checks are associated with a significant reduction in premature mortality, evident after 10 years of follow-up. This suggests a potential cumulative benefit of participation in the programme. These findings reinforce the importance of expanding access to NHS Health Checks to address CVD prevention. While the COVID-19 pandemic introduced additional complexity, including increased premature mortality and reduced programme uptake, the protective effects of NHS Health Checks observed during this time highlight their value. These results underscore the importance of continued investment in CVD prevention programmes on a population-wide scale.

ABSTRACTIntroductionPreventive health services, such as the NHS Health Check programme, aim to identify and address key health risks, yet participation is particularly low in socioeconomically deprived areas, such as the North East of England. Understanding barriers and facilitators to engagement is critical to improving access and outcomes for these communities. This study aimed to explore barriers and facilitators to NHS Health Check attendance in these underserved communities using a participatory research approach.MethodsThis study employed a qualitative design with a participatory approach, involving peer researchers from the target communities. Two peer research associates (PRAs) from socioeconomically deprived areas were trained to conduct semi‐structured online or telephone interviews with 12 community members eligible for NHS Health Checks. Additionally, 5 stakeholders involved in the programme's delivery were interviewed. Thematic analysis was conducted in collaboration with the PRAs to ensure community perspectives were authentically captured.ResultsBarriers to participation included limited awareness, cultural perceptions of self‐reliance, fear of health‐related discoveries, mistrust of healthcare systems and logistical challenges exacerbated by structural inequalities. Participants emphasised the need for culturally tailored communication and flexible, accessible health checks. Stakeholders highlighted the role of collaboration, targeted outreach and digital tools in addressing these barriers.ConclusionThe study highlights key barriers to NHS Health Check uptake in socioeconomically deprived communities in the North East of England. Improving communication, increasing accessibility through community‐based services and building trust in healthcare are recommended key strategies to enhance participation and reduce health inequalities in these regions.Patient or Public ContributionPeer researchers, individuals with lived experience of being from socioeconomically deprived communities in North East England and eligible for NHS Health Checks, were involved in the design and conduct of this study. They were trained to conduct interviews with community members and contributed to the thematic analysis, ensuring that public perspectives were integral to the interpretation of the data.

IntroductionIn England, eligible adults aged 40–74 years are invited to attend a face-to-face (F2F) NHS Health Check appointment every 5 years. A digital version of the Health Check was introduced...

ObjectivesThere is a need to better inform clinicians and decision-makers in primary or community care settings on selecting the appropriate point-of-care tests (POCTs) for screening purposes (as a part of...

Birmingham has a significantly higher type-II diabetes prevalence than the national average. This study aimed to investigate the association of socioeconomic deprivation and ethnicity on the risk of diabetes in Birmingham. Data were included from 108,514 NHS Health Checks conducted in Birmingham between 2018 and 2023. Attributable fraction and multinomial logistic regression were used to estimate the number of events avoidable and the prevalence odds ratios (POR) of determinants respectively. Attributable fraction analysis estimated that 64% of diabetes and 44% of pre-diabetes cases could be attributed to socioeconomic deprivation. Specifically, if Asian attendees in the least deprived areas had the same risk as White individuals in the least deprived areas, there would have been 1,056 fewer cases of diabetes and 2,226 fewer cases of pre-diabetes. Diabetes was significantly associated with Asian ethnicity (POR = 5.43, p < 0.001), Black ethnicity (POR = 3.15, p < 0.001) and Mixed ethnicity (POR = 2.79, p < 0.001). Pre-diabetes was also significantly associated with Asian ethnicity (POR = 3.06, p < 0.001), Black ethnicity (POR = 2.70, p < 0.001) and Mixed ethnicity (POR = 2.21, p < 0.001). The interaction effects between ethnicity and deprivation posed a greater risk of diabetes, especially for Asian attendees in the first (POR = 9.34, p < 0.001) and second (POR = 6.24, p < 0.001) most deprived quintiles. The present findings demonstrate the association of ethnicity and socioeconomic deprivation on the risk of diabetes and pre-diabetes. It underscores the necessity for targeted interventions and policies to address these inequalities.

ObjectivesTo compare the uptake, effectiveness and costs of a digital version of the National Health Service (NHS) Health Check (DHC) to the standard face-to-face NHS Health Check (F2F).Participants and settingA...

BackgroundMigrants to the UK face disproportionate risk of infections, non-communicable diseases, and under-immunisation compounded by healthcare access barriers. Current UK migrant screening strategies are unstandardised with poor implementation and low uptake. Health Catch-UP! is a collaboratively produced digital clinical decision support system that applies current guidelines (UKHSA and NICE) to provide primary care professionals with individualised multi-disease screening (7 infectious diseases/blood-borne viruses, 3 chronic parasitic infections, 3 non-communicable disease or risk factors) and catch-up vaccination prompts for migrant patients.MethodsWe carried out a mixed-methods process evaluation of Health Catch-UP! in two urban primary healthcare practices to integrate Health Catch-UP! into the electronic health record system of primary care, using the Medical Research Council framework for complex intervention evaluation. We collected quantitative data (demographics, patients screened, disease detection and catch-up vaccination rates) and qualitative participant interviews to explore acceptability and feasibility.ResultsNinety-nine migrants were assessed by Health Catch-UP! across two sites (S1, S2). 96.0% (n = 97) had complete demographics coding with Asia 31.3% (n = 31) and Africa 25.2% (n = 25), the most common continents of birth (S1 n = 92 [48.9% female (n = 44); mean age 60.6 years (SD 14.26)]; and S2 n = 7 [85.7% male (n = 6); mean age 39.4 years (SD16.97)]. 61.6% (n = 61) of participants were eligible for screening for at least one condition and uptake of screening was high 86.9% (n = 53). Twelve new conditions were identified (12.1% of study population) including hepatitis C (n = 1), hypercholesteraemia (n = 6), pre-diabetes (n = 4), and diabetes (n = 1). Health Catch-UP! identified that 100% (n = 99) of patients had no immunisations recorded; however, subsequent catch-up vaccination uptake was poor (2.0%, n = 1). Qualitative data supported acceptability and feasibility of Health Catch-UP! from staff and patient perspectives, and recommended Health Catch-UP! integration into routine care (e.g. NHS health checks) with an implementation package including staff and patient support materials, standardised care pathways (screening and catch-up vaccination, laboratory, and management), and financial incentivisation.ConclusionsClinical Decision Support Systems like Health Catch-UP! can improve disease detection and implementation of screening guidance for migrant patients but require robust testing, resourcing, and an effective implementation package to support both patients and staff.

A cardiovascular disease polygenic risk score (CVD-PRS) can stratify individuals into different categories of cardiovascular risk, but whether the addition of a CVD-PRS to clinical risk scores improves the identification of individuals at increased risk in a real-world clinical setting is unknown. The Genetics and the Vascular Health Check Study (GENVASC) was embedded within the UK National Health Service Health Check (NHSHC) programme which invites individuals between 40-74 years of age without known CVD to attend an assessment in a UK general practice where CVD risk factors are measured and a CVD risk score (QRISK2) is calculated. Between 2012-2020, 44,141 individuals (55.7% females, 15.8% non-white) who attended an NHSHC in 147 participating practices across two counties in England were recruited and followed. When 195 individuals (cases) had suffered a major CVD event (CVD death, myocardial infarction or acute coronary syndrome, coronary revascularisation, stroke), 396 propensity-matched controls with a similar risk profile were identified, and a nested case-control genetic study undertaken to see if the addition of a CVD-PRS to QRISK2 in the form of an integrated risk tool (IRT) combined with QRISK2 would have identified more individuals at the time of their NHSHC as at high risk (QRISK2 10-year CVD risk of ≥10%), compared with QRISK2 alone. The distribution of the standardised CVD-PRS was significantly different in cases compared with controls (cases mean score .32; controls, -.18, P = 8.28×10-9). QRISK2 identified 61.5% (95% confidence interval [CI]: 54.3%-68.4%) of individuals who subsequently developed a major CVD event as being at high risk at their NHSHC, while the combination of QRISK2 and IRT identified 68.7% (95% CI: 61.7%-75.2%), a relative increase of 11.7% (P = 1×10-4). The odds ratio (OR) of being up-classified was 2.41 (95% CI: 1.03-5.64, P = .031) for cases compared with controls. In individuals aged 40-54 years, QRISK2 identified 26.0% (95% CI: 16.5%-37.6%) of those who developed a major CVD event, while the combination of QRISK2 and IRT identified 38.4% (95% CI: 27.2%-50.5%), indicating a stronger relative increase of 47.7% in the younger age group (P = .001). The combination of QRISK2 and IRT increased the proportion of additional cases identified similarly in women as in men, and in non-white ethnicities compared with white ethnicity. The findings were similar when the CVD-PRS was added to the atherosclerotic cardiovascular disease pooled cohort equations (ASCVD-PCE) or SCORE2 clinical scores. In a clinical setting, the addition of genetic information to clinical risk assessment significantly improved the identification of individuals who went on to have a major CVD event as being at high risk, especially among younger individuals. The findings provide important real-world evidence of the potential value of implementing a CVD-PRS into health systems.

Around 40% of adults have pre-hypertension (120-139/80-89mmHg) increasing their risk of developing hypertension and associated cardiovascular conditions. Guidance on pre-hypertension management focuses on improving lifestyle. Self-monitoring may improve awareness and understanding of blood pressure (BP) for people with pre-hypertension, allowing them to modify their lifestyle risks. To determine the fidelity to and utility of a home BP self-monitoring regime in people with pre-hypertension. This sub-study is part of a larger prospective, non-randomised feasibility study. Individuals with pre-hypertension were identified via GP records and pharmacy NHS Health Checks in Northwest England. Participants received training for home BP self-monitoring. They were asked to complete two readings (leaving a 5-minute interval) on the first three days of the month for six months, colour-code their readings and take action using a simple algorithm, then send them to the research team within 7 days. Eighty participants (aged 40-79, mean=59) enrolled. The majority were female (n=45, 56%), White British (n=79, 99%), and had not previously monitored their BP (n=55, 69%). Seventy-five (94%) participants completed the training. Sixty-one (81%) received online training and 14 (19%) opted for a face-to-face session. Sixty-one (81%) completed all six months of readings, 51 (68%) also returned them on time. All in-person training participants completed all six months of readings on time. Reasons for non-compliance to the protocol included battery issues, forgetting, and struggling to find a consistent time for readings. Home BP self-monitoring can be feasible and easily implementable for people with pre-hypertension - however, some barriers were identified.

BackgroundNHS Health Check (NHSHC) is a national cardiovascular disease (CVD) risk identification and management programme. However, evidence suggests a limited understanding of the most used metric to communicate CVD risk with patients (10-year percentage risk). This study used novel application of video-stimulated recall interviews to understand patient perceptions and understanding of CVD risk following an NHSHC that used one of two different CVD risk calculators.MethodsQualitative, semi-structured video-stimulated recall interviews were conducted with patients (n = 40) who had attended an NHSHC using either the QRISK2 10-year risk calculator (n = 19) or JBS3 lifetime CVD risk calculator (n = 21). Interviews were transcribed and analysed using reflexive thematic analysis.ResultsAnalysis resulted in the development of four themes: variability in understanding, relief about personal risk, perceived changeability of CVD risk, and positive impact of visual displays. The first three themes were evident across the two patient groups, regardless of risk calculator; the latter related to JBS3 only. Patients felt relieved about their CVD risk, yet there were differences in understanding between calculators. Heart age within JBS3 prompted more accessible risk appraisal, yet mixed understanding was evident for both calculators. Event-free survival age also resulted in misunderstanding. QRISK2 patients tended to question the ability for CVD risk to change, while risk manipulation through JBS3 facilitated this understanding. Displaying information visually also appeared to enhance understanding.ConclusionsEffective communication of CVD risk within NHSHC remains challenging, and lifetime risk metrics still lead to mixed levels of understanding in patients. However, visual presentation of information, alongside risk manipulation during NHSHCs can help to increase understanding and prompt risk-reducing lifestyle changes.Trial registrationISRCTN10443908. Registered 7th February 2017.

To compare the NHS Health Check Programme with the Polypill Prevention Programme in the primary prevention of heart attacks and strokes. Use of published data and methodology to produce flow charts of the two programmes to determine screening performance and heart attacks and strokes prevented. The UK population. The NHS Health Check Programme using a QRISK score on people aged 40-74 to select those eligible for a statin is compared with the Polypill Prevention Programme in people aged 50 or more to select people for a combination of a statin and three low-dose blood pressure lowering agents. In both programmes, people had no history of heart attack or stroke. In 1000 people, the number of heart attacks and strokes prevented in the two programmes. In the hypothetical perfect situation with 100% uptake and adherence to the screening protocol, in every 1000 persons, the NHS Health Check would prevent 287 cases of a heart attack or stroke in individuals who would gain on average about 4 years of life without a heart attack or stroke amounting to 1148 years in total, the precise gain depending on the extent of treatment for those with raised blood pressure, and 136 would be prescribed statins with no benefit. The corresponding figures for the Polypill Prevention Programme are 316 individuals who would, on average, gain 8 years of life without a heart attack or stroke, amounting to 2528 years in total, and 260 prescribed the polypill with no benefit. Based on published estimates of uptake and adherence in the NHS Health Check Programme, in practice only 24 cases per 1000 are currently benefitting instead of 287, amounting to 96 years gained without a heart attack or stroke. The Polypill Prevention Programme is by design simpler with the potential of preventing many more heart attacks and strokes than the NHS Health Check Programme.

BackgroundThe NHS Health Check is a preventive programme in the UK designed to screen for cardiovascular risk and to aid in primary disease prevention. Despite its widespread implementation, the effectiveness of the NHS Health Check for longer-term disease prevention is unclear. In this study, we measured the rate of new diagnoses in UK Biobank participants who underwent the NHS Health Check compared with those who did not.MethodsWithin the UK Biobank prospective study, 48,602 NHS Health Check recipients were identified from linked primary care records. These participants were then covariate-matched on an extensive range of socio-demographic, lifestyle, and medical factors with 48,602 participants without record of the check. Follow-up diagnoses were ascertained from health records over an average of 9 years (SD 2 years) including hypertension, diabetes, hypercholesterolaemia, stroke, dementia, myocardial infarction, atrial fibrillation, heart failure, fatty liver disease, alcoholic liver disease, liver cirrhosis, liver failure, acute kidney injury, chronic kidney disease (stage 3 +), cardiovascular mortality, and all-cause mortality. Time-varying survival modelling was used to compare adjusted outcome rates between the groups.ResultsIn the immediate 2 years after the NHS Health Check, higher diagnosis rates were observed for hypertension, high cholesterol, and chronic kidney disease among health check recipients compared to their matched counterparts. However, in the longer term, NHS Health Check recipients had significantly lower risk across all multiorgan disease outcomes and reduced rates of cardiovascular and all-cause mortality.ConclusionsThe NHS Health Check is linked to reduced incidence of disease across multiple organ systems, which may be attributed to risk modification through earlier detection and treatment of key risk factors such as hypertension and high cholesterol. This work adds important evidence to the growing body of research supporting the effectiveness of preventative interventions in reducing longer-term multimorbidity.

The aim of the study was to investigate the potential effect of different structural interventions for preventing cardiovascular disease. Medline and EMBASE were searched for peer-reviewed simulation-based studies of structural interventions for prevention of cardiovascular disease. We performed a systematic narrative synthesis. A total of 54 studies met the inclusion criteria. Diet, nutrition, tobacco and alcohol control and other programmes are among the policy simulation models explored. Food tax and subsidies, healthy food and lifestyles policies, palm oil tax, processed meat tax, reduction in ultra-processed foods, supplementary nutrition assistance programmes, stricter food policy and subsidised community-supported agriculture were among the diet and nutrition initiatives. Initiatives to reduce tobacco and alcohol use included a smoking ban, a national tobacco control initiative and a tax on alcohol. Others included the NHS Health Check, WHO 25 × 25 and air quality management policy. There is significant heterogeneity in simulation models, making comparisons of output data impossible. While policy interventions typically include a variety of strategies, none of the models considered possible interrelationships between multiple policies or potential interactions. Research that investigates dose-response interactions between numerous modifications as well as longer-term clinical outcomes can help us better understand the potential impact of policy-level interventions. The reviewed studies underscore the potential of structural interventions in addressing cardiovascular diseases. Notably, interventions in areas such as diet, tobacco, and alcohol control demonstrate a prospective decrease in cardiovascular incidents. However, to realize the full potential of such interventions, there is a pressing need for models that consider the interplay and cumulative impacts of multiple policies. Rigorous research into holistic and interconnected interventions will pave the way for more effective policy strategies in the future. The study is registered as PROSPERO CRD42019154836. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/148/05.

BackgroundDelays in preventative service uptake are increasing in the UK. Universal, comprehensive monthly outreach by Community Health and Wellbeing Workers (CHW), who are integrated at the GP practice and local authority, offer a promising alternative to general public health campaigns as it personalises health promotion and prevention of disease holistically at the household level. We sought to test the ability of this model, which is based on the Brazilian Family Health Strategy, to increase prevention uptake in the UK.MethodsAnalysis of primary care patient records for 662 households that were allocated to five CHWWs from July 2021. Primary outcome was the Composite Referral Completion Indicator (CRCI), a measure of how many health promotion activities were received by members of a household relative to the ones that they were eligible for during the period July 2021-April 2022. The CRCI was compared between the intervention group (those who had received at least one visit) and the control group (allocated households that were yet to receive a visit). A secondary outcome was the number of GP visits in the intervention and control groups during the study period and compared to a year prior.ResultsIntervention and control groups were largely comparable in terms of household occupancy and service eligibilities. A total of 2251 patients in 662 corresponding households were allocated to 5 CHWs and 160 households had received at least one visit during the intervention period. The remaining households were included in the control group. Overall service uptake was 40% higher in the intervention group compared to control group (CRCI: 0.21 ± 0.15 and 0.15 ± 0.19 respectively). Likelihood of immunisation uptake specifically was 47% higher and cancer screening and NHS Health Checks was 82% higher. The average number of GP consultations per household decreased by 7.4% in the intervention group over the first 10 months of the pilot compared to the 10 months preceding its start, compared with a 0.6% decrease in the control group.ConclusionsDespite the short study period these are promising findings in this deprived, traditionally hard to reach community and demonstrates potential for the Brazilian community health worker model to be impactful in the UK. Further analysis is needed to examine if this approach can reduce health inequalities and increase cost effectiveness of health promotion approaches.

This study investigated NHS Health Check programme delivery before and after the Covid-19 pandemic response, with a focus on support services and referral methods available to Health Check attendees. The NHS Health Check is an important part of England's Cardiovascular Disease (CVD) prevention programme. Public health commissioners from all 151 local authorities responsible for commissioning the NHS Health Check programme were surveyed in 2021, using an online questionnaire to capture detail about programme delivery, changes in delivery because of the pandemic response, and monitoring of programme outcomes. Four-point rating scales were used to obtain level of confidence in capacity, accessibility and usage of follow-on support services for Health Check attendees. A typology of programme delivery was developed, and associations between delivery categories and a range of relevant variables were assessed using one-way analysis of variance. Sixty-eight responses were received on behalf of 74 (of 151) local authorities (49%), across all geographical regions. Our findings suggest a basic typology of delivery, though with considerable variation in who is providing the Checks, where and how, and with continued changes prompted by the Covid-19 pandemic. Support for risk management is highly varied with notable gaps in some areas. Local authorities using a model of delivery that includes community venues tended to have a higher number of services to support behaviour change following the Check, and greater confidence in the accessibility and usage of these services. A minority of local authorities gather data on referrals for Health Check attendees, or on outcomes of referrals. The Covid-19 pandemic has prompted continued changes in delivery, which are likely to influence patient experience and outcomes; these need careful evaluation. The programme's delivery and commissioners' intentions to follow through risk communication with appropriate support is challenged by the complexity of the commissioning landscape.

BackgroundGPs play an increasingly important role in proactively preventing dementia. Dementia in 40% of patients could be prevented or delayed by targeting 12 modifiable risk factors throughout life. However, little is known about how GPs perceive their role in dementia prevention and the associated barriers.AimTo explore the role of GPs in dementia prevention.Design and settingQualitative study among UK GPs.MethodSemi-structured online interviews were conducted with 11 UK GPs exploring their views regarding their role in dementia prevention. Data were analysed using thematic analysis.ResultsGPs reported that they never explicitly discuss dementia risk with patients, even when patients are presenting with risk factors, but acknowledge that dementia prevention should be part of their role. They advocate for adopting a whole team approach to primary care preventive practice, using long-term condition/medication reviews or NHS health checks as a platform to enable dementia risk communication targeting already at-risk individuals. Barriers included a lack of time and an absence of knowledge and education about the modifiable dementia risk factors, as well as a reluctance to use ‘dementia’ as a term within the appointment for fear of causing health anxiety. ‘Brain health’ was perceived as offering a more encouraging discursive tool for primary care practitioners, supporting communication and behaviour change.ConclusionThere needs to be a whole-systems shift towards prioritising brain health and supporting primary care professionals in their preventive role. Education is key to underpinning this role in dementia prevention.