Be SMART: examining the experience of implementing the NHS Health Check in UK primary care

ObjectiveTo determine if use of point of care testing (POCT) is less costly than laboratory testing to the National Health Service (NHS) in delivering the NHS Health Check (NHSHC) programme in the primary care setting.DesignObservational study and theoretical mathematical model with microcosting approach.SettingWe collected data on NHSHC delivered at nine general practices (seven using POCT; two not using POCT).ParticipantsWe recruited nine general practices offering NHSHC and a pathology services laboratory in the same area.MethodsWe conducted mathematical modelling with permutations in the following fields: provider type (healthcare assistant or nurse), type of test performed (total cholesterol with either lab fasting glucose or HbA1c), cost of consumables and variable uptake rates, including rate of non-response to invite letter and rate of missed [did not attend (DNA)] appointments. We calculated total expected cost (TEC) per 100 invites, number of NHSHC conducted per 100 invites and costs for completed NHSHC for laboratory and POCT-based pathways. A univariate and probabilistic sensitivity analysis was conducted to account for uncertainty in the input parameters.Main outcome measuresWe collected data on cost, volume and type of pathology services performed at seven general practices using POCT and a pathology services laboratory. We collected data on response to the NHSHC invitation letter and DNA rates from two general practices.ResultsTEC of using POCT to deliver a routine NHSHC is lower than the laboratory-led pathway with savings of £29 per 100 invited patients up the point of cardiovascular disease risk score presentation. Use of POCT can deliver NHSHC in one sitting, whereas the laboratory pathway offers patients several opportunities to DNA appointment.ConclusionsTEC of using POCT to deliver an NHSHC in the primary care setting is lower than the laboratory-led pathway. Using POCT minimises DNA rates associated with laboratory testing and enables completion of NHSHC in one sitting.

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GPs' perspectives on managing the NHS Health Check in primary care: a qualitative evaluation of implementation in one area of England: Table 1

BMJ Open ◽

10.1136/bmjopen-2015-010951 ◽

2016 ◽

Vol 6 (7) ◽

pp. e010951 ◽

Cited By ~ 9

Author(s):

Rachel L Shaw ◽

Helen Lowe ◽

Carol Holland ◽

Helen Pattison ◽

Richard Cooke

Keyword(s):

Primary Care ◽

Qualitative Evaluation ◽

Health Check ◽

Nhs Health Check

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Variations in the organization and delivery of the 'NHS health check' in primary care

Journal of Public Health ◽

10.1093/pubmed/fds062 ◽

2012 ◽

Vol 35 (1) ◽

pp. 85-91 ◽

Cited By ~ 26

Author(s):

J. M. Nicholas ◽

C. Burgess ◽

H. Dodhia ◽

J. Miller ◽

F. Fuller ◽

...

Keyword(s):

Primary Care ◽

Health Check ◽

Nhs Health Check

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Incorporating a brief intervention for personalised cancer risk assessment to promote behaviour change into primary care: a multi-methods pilot study

BMC Public Health ◽

10.1186/s12889-021-10210-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Katie Mills ◽

Ben Paxton ◽

Fiona M. Walter ◽

Simon J. Griffin ◽

Stephen Sutton ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Pilot Study ◽

Cancer Risk ◽

Behaviour Change ◽

Brief Intervention ◽

Health Check ◽

Health Checks ◽

Nhs Health Checks ◽

Nhs Health Check

Abstract Background Approximately 40% of cancers could be prevented if people lived healthier lifestyles. We have developed a theory-based brief intervention to share personalised cancer risk information and promote behaviour change within primary care. This study aimed to assess the feasibility and acceptability of incorporating this intervention into primary care consultations. Method Patients eligible for an NHS Health Check or annual chronic disease review at five general practices were invited to participate in a non-randomised pilot study. In addition to the NHS Health Check or chronic disease review, those receiving the intervention were provided with their estimated risk of developing the most common preventable cancers alongside tailored behaviour change advice. Patients completed online questionnaires at baseline, immediately post-consultation and at 3-month follow-up. Consultations were audio/video recorded. Patients (n = 12) and healthcare professionals (HCPs) (n = 7) participated in post-intervention qualitative interviews that were analysed using thematic analysis. Results 62 patients took part. Thirty-four attended for an NHS Health Check plus the intervention; 7 for a standard NHS Health Check; 16 for a chronic disease review plus the intervention; and 5 for a standard chronic disease review. The mean time for delivery of the intervention was 9.6 min (SD 3) within NHS Health Checks and 9 min (SD 4) within chronic disease reviews. Fidelity of delivery of the intervention was high. Data from the questionnaires demonstrates potential improvements in health-related behaviours following the intervention. Patients receiving the intervention found the cancer risk information and lifestyle advice understandable, useful and motivating. HCPs felt that the intervention fitted well within NHS Health Checks and facilitated conversations around behaviour change. Integrating the intervention within chronic disease reviews was more challenging. Conclusions Incorporating a risk-based intervention to promote behaviour change for cancer prevention into primary care consultations is feasible and acceptable to both patients and HCPs. A randomised trial is now needed to assess the effect on health behaviours. When designing that trial, and other prevention activities within primary care, it is necessary to consider challenges around patient recruitment, the HCP contact time needed for delivery of interventions, and how best to integrate discussions about disease risk within routine care.

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What do patients want? A qualitative exploration of patients’ needs and expectations regarding online access to their primary care record

British Journal of General Practice ◽

10.3399/bjgp20x711245 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711245

Author(s):

Gail Davidge ◽

Caroline Sanders ◽

Rebecca Hays ◽

Rebecca Morris ◽

Helen Atherton ◽

...

Keyword(s):

Primary Care ◽

Thematic Analysis ◽

Support Needs ◽

Future Design ◽

Wide Range ◽

Primary Care Record ◽

Online Access ◽

Qualitative Exploration ◽

Nhs Health Check ◽

Patients Wishes

BackgroundPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. GP contracts in England state practices must promote and offer registered patients online access to their primary care record and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access.AimTo explore patients’ views about accessing online primary care records and to find out how patients would like to interact with their records and what support they may need.MethodInterviews and focus groups with a sample of 50 patients from a variety of socio-demographic backgrounds who were either; eligible for the NHS Health Check; had multimorbidities or were carers. Thematic analysis of data identified major themes impacting upon patients’ wishes and needs as well as highlighting population-specific issues.ResultsParticipants highlighted a wide range of views about the benefits and drawbacks of accessing their records online. The majority of participants indicated that they would be more likely to access their online primary care record if improvements were made to the design, reliability and functionality of existing online record services. Carers found accessing online records particularly useful.ConclusionConsultation with patients and carers about their experiences of accessing online records; support needs and preferred functions can provide useful insights to inform the future design of online record services.

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NHS Health Checks for people with mental ill-health 2013–2017: an observational study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001006 ◽

2020 ◽

Vol 29 ◽

Author(s):

C. Garriga ◽

J. Robson ◽

C. Coupland ◽

J. Hippisley-Cox

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Events ◽

Health Check ◽

Health Checks ◽

Hazard Ratios ◽

Nationally Representative ◽

Nhs Health Checks ◽

Nhs Health Check

Abstract Aims People living with serious mental ill-health experience adverse cardiovascular outcomes causing some of the greatest health inequality gaps in England, UK. We describe uptake of the NHS Health Check programme in people with mental ill-health, and rates of new diagnoses and management of cardiovascular risk factors in those who attend NHS Health Checks in comparison to those people without mental ill-health. Methods We used a large nationally representative database of people registered with general practitioners in England (QResearch). Between 2013 and 2017, we analysed attendance at NHS Health Checks and outcomes in the succeeding 12 months, in people with serious mental illness (SMI) including psychoses and in people prescribed long-term antidepressant medications (LTAD), with comparison to attendees who did not have these conditions. Hazard ratios (HR) were used to describe the association between outcomes and SMI and LTAD adjusting for sociodemographic variables. Results In those eligible for the NHS Health Check programme, we found a higher percentage of people with SMI attended an NHS Health Check (65 490, 19.8%) than those without SMI (524 728, 16.6%); adjusted HR 1.05 [95% confidence interval 1.02–1.08]. We also observed a higher percentage of attendance in people on LTAD (46 437, 20.1%) compared to people who were not prescribed LTAD (543 781, 16.7%); adjusted HR 1.10 (1.08–1.13). People with SMI were more likely to be identified with chronic kidney disease (CKD, HR 1.23, 1.12–1.34) and type 2 diabetes (HR 1.14, 1.03–1.25) within the 12 months following their NHS Health Check compared with those without SMI. People on LTAD were more likely to be identified with CKD (HR 1.55, 1.42–1.70) and type 2 diabetes (HR 1.45, 1.31–1.60) and also hypertension, cardiovascular disease, non-diabetic hyperglycaemia, familial hypercholesterolemia and dementia within the 12 months following their NHS Health Check. Statins were more likely to be prescribed to NHS Health Check attendees with SMI and those on LTAD than those without these conditions; HR 1.31 (1.25–1.38) and 1.91 (1.82–2.01), respectively. Antihypertensives were more likely to be prescribed to those on LTAD; HR 1.21 (1.14–1.29). Conclusions We found evidence that people with SMI or on LTAD treatment were 5–10% more likely to access NHS Health Checks than people without these conditions. People with SMI or on LTAD treatment who attended NHS Health Checks had higher rates of diagnosis of CKD, type 2 diabetes and some other relevant co-morbidities and increased treatment with statins and also anti-hypertensive medication in people on LTAD. This is likely to contribute to equitable reduction in adverse cardiovascular events for people with mental ill-health.

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Moving from Assessing Cardiovascular Risk to Altering Risk Trajectories: Opportunities Revealed by England’s NHS Health Check Programme

SSRN Electronic Journal ◽

10.2139/ssrn.3924714 ◽

2021 ◽

Author(s):

Riyaz Patel ◽

Sharmani Barnard ◽

Catherine Lagord ◽

Katherine Thompson ◽

Andrew Hughes ◽

...

Keyword(s):

Cardiovascular Risk ◽

Health Check ◽

Nhs Health Check

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Reasons why people do not attend NHS Health Checks: a systematic review and qualitative synthesis

British Journal of General Practice ◽

10.3399/bjgp17x693929 ◽

2017 ◽

Vol 68 (666) ◽

pp. e28-e35 ◽

Cited By ~ 16

Author(s):

Emma Harte ◽

Calum MacLure ◽

Adam Martin ◽

Catherine L Saunders ◽

Catherine Meads ◽

...

Keyword(s):

Systematic Review ◽

Health Management ◽

Health Check ◽

Cochrane Library ◽

Inclusion Criteria ◽

Qualitative Synthesis ◽

Health Checks ◽

The Impact ◽

Nhs Health Checks ◽

Nhs Health Check

BackgroundThe NHS Health Check programme is a prevention initiative offering cardiovascular risk assessment and management advice to adults aged 40–74 years across England. Its effectiveness depends on uptake. When it was introduced in 2009, it was anticipated that all those eligible would be invited over a 5-year cycle and 75% of those invited would attend. So far in the current cycle from 2013 to 2018, 33.8% of those eligible have attended, which is equal to 48.5% of those invited to attend. Understanding the reasons why some people do not attend is important to maximise the impact of the programmes.AimTo review why people do not attend NHS Health Checks.Design and settingA systematic review and thematic synthesis of qualitative studies.MethodAn electronic literature search was carried out of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index to Nursing and Allied Health Literature, Global Health, PsycINFO, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov, and the ISRCTN registry from 1 January 1996 to 9 November 2016, and the reference lists of all included papers were also screened manually. Inclusion criteria were primary research studies that reported the views of people who were eligible for but had not attended an NHS Health Check.ResultsNine studies met the inclusion criteria. Reasons for not attending included lack of awareness or knowledge, misunderstanding the purpose of the NHS Health Check, aversion to preventive medicine, time constraints, difficulties with access to general practices, and doubts regarding pharmacies as appropriate settings.ConclusionThe findings particularly highlight the need for improved communication and publicity around the purpose of the NHS Health Check programme and the personal health benefits of risk factor detection.

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