Foreword – Dr Dawn Harper (GP and TV presenter)
I was delighted to be asked to take part in the NHS Health Check national conference at the Royal Armouries in Leeds last month. While many of you may know me from the work I do on TV (on programmes such as ‘Embarrassing Bodies’ and ‘This Morning’), I am first and foremost a GP working in the community in Gloucestershire. During my career I have seen first-hand the impact that behavioural and physiological risk factors can have on individuals and on their families and friends. That’s why I wanted to take part in the conference because I know what an important role GPs and other health professionals play in getting serious about disease prevention.
I am a real fan of the NHS Health Check. Up until recent years we haven’t had a national health service, we have had a national ill service. The NHS Health Check provides a tremendous opportunity for primary care to be more proactive about prevention rather than our historical focus on cure and disease management. The NHS is facing possible bankruptcy due to non-communicable diseases, with type 2 diabetes alone possibly financially crippling the NHS if we don’t do something about it soon.
While talking to delegates at the conference, I was inspired by the enthusiasm and dedication from all colleagues working on this programme. Listening to the workshops and visiting the marketplace, there is a wealth of talent and innovation that is helping to shape the NHS Health Check as a world leading prevention programme. You should all be very proud of your achievements to date.
Disease prevention is something that GPs and more widely primary care have to make their business if we are going to protect the NHS from the growing demands attributed to preventable disease. I am committed to raising the profile of the NHS Health Check and working with you all to make this programme work. It will only be through strong clinical and public health leadership that we will be able to secure the NHS for the next generation, something we should all be passionate about.
Operational update from Jamie Waterall
I want to start this operational update by thanking everyone who was involved in this year’s annual NHS Health Check conference. This was PHE’s second national conference, attended by over 430 delegates and this year took place in Leeds. I have to especially thank Dr Dawn Harper for agreeing to chair the conference and for her continued support for the NHS Health Check programme. I am also enormously grateful to all those people who presented on the day, your enthusiasm and willingness to share key learning with delegates is what makes these events possible.
Of those who completed their evaluation forms, 88% rated the conference as either excellent or good, which we are very pleased with. However, we have taken the time to read your evaluation forms and have already started to think about how we make next year’s event even better. If any of you have any thoughts on this do get in touch.
Thank you to all the teams who submitted a poster for our first poster awards held at this conference. I would like to congratulate Durham County Council on winning the competition. I have been fortunate to have visited the County Durham team and know that their approach to delivering the NHS Health Check programme is exceptional. Their focus on accessibility, quality and outcomes is admirable and I was pleased that delegates at our conference recognised their achievements.
All the presentations from the conference are on the NHS Health Check website. We filmed all of the main presentations and some of the workshops and these are also available on the website. We also filmed lots of other things happening at the conference including the poster competition and the marketplace, and captured your views about the programme and the day. We have made this into a short film which again you can see on the website.
Last year, our expert scientific and clinical advisory panel agreed to the Joint British Society 3 (JBS) risk guidelines being developed into a public facing tool, hosted on NHS Choices. The tool raises awareness of the key behavioural and physiological risk factors that increase your risk of cardiovascular disease, while also raising awareness of the NHS Health Check programme. Since launch we have had almost one million visits to the web page and 405,000 people have completed the full test. This has been a great partnership between PHE, JBS, British Heart Foundation and NHS Choices, and we will continue to update you on the findings and evaluation of this new tool.
New marketing materials have been added to the template assets on the NHS Health Check website.
- two designs of 48-sheet (roadside) posters and a smaller six-sheet design (bus stops, shopping centres)
- two sizes of “empty belly” posters for supporting employer or other local NHS Health Check campaigns in places such as community venues and pharmacies
- radio scripts that can be adapted for local campaigns
- A5 flyer
- appointment card
A new section on the website has been created with examples of local campaigns.
Revised best practice guidance published
An updated version of the NHS Health Check best practice guidance is now available on the NHS Health Check website. The guidance supports local authorities and providers to deliver the NHS Health Check programme. It includes legal requirements and best practice on delivering the risk assessment, awareness and management elements of the programme.
Key changes from the previous best practice guidance edition include:
- a new programme pathway diagram to accompany the existing clinical flow chart
- clarification of local authority’s legal duty to deliver the programme
- clarification of NHS England’s legal duty to deliver the programme in prisons and detained settings
- removing the recommendation to use Framingham as a risk score calculator, in line with NICE guidance
- recommending that a pulse rythmn check is completed as part of the blood pressure check, in line with NICE guidance
- new information on the use of point of care testing
- recommending that statins are considered for people with a cardiovascular disease risk greater than 10%, in line with NICE guidance
- new information on communication and marketing
- new information on training, learning and development
- new information on national programme governance
- new information on information governance and data flow.
New training videos now available
Following requests from local teams, PHE has developed several videos to assist people who carry out NHS Health Check. One of the videos shows how to carry out an NHS Health Check and the other videos show motivational behaviour change techniques. The videos can be used as part of local training programmes and are available on the NHS Health Check website.
Local authority NHS Health Check case studies published
The Local Government Association has published ‘Checking the health of the nation: implementing the NHS Health Check programme’, which includes case studies on delivery from:
- Southwark’s use of volunteers to boost uptake
- Stoke-on-Trent council using research to engage hard-to-reach groups
- Leeds city council providing support to GPs to increase uptake
- Buckinghamshire county council running outreach clinics to target hard-to-reach groups
- Lewisham using pharmacists to deliver NHS Health Check
New NHS Health Check data codes released
After much collaborative work and with thanks to colleagues in the Health and Social Care Information Centre (HSCIC), we have an updated set of data codes for the NHS Health Check.
A set of data codes, sometimes referred to as a data set have been agreed as suitable for collecting information about a specific programme. This is not to be confused with a data standard, which is a data set that has moved through a complex process to assess burden, accuracy, legality in respect to national data extraction etc. Over the next year we will move to having a data standard, subject to acceptance by the relevant authorities within the HSCIC. This will enable us to request national data extracts for the first time to develop a greater understanding of the programme at a national level.
There are a number of new narrative descriptions with codes attached, this is to add detail to reporting where required and to better understand uptake of services.
You will also note for the first time there is a set of SNOMED codes, we have been advised by the HSCIC that:
- Read 2 codes should now only be used for legacy projects and will be phased out over the next couple of years there is no direct support for Read 2 codes any longer
- CTv3 codes will be phased out some time after Read 2 (perhaps 2017/18) until we get a point where only SNOMED codes are being used (c.2019/2020)
- this aligns us with the international process of linking reporting under a single reporting system, ie, SNOMED
Time scales for changing to SNOMED are a local decision within the wider health community. Some of the detail on the template may appear confusing but it is there to help data analysts in understanding the scope of the individual SNOMED codes.
Priorities for research published
Following a consultation on the proposed research priorities for the NHS Health Check programme an updated document incorporating views has been published. This is part of our commitment to bring greater scientific rigour to the NHS Health Check and the priorities for research is an important step in establishing the key evidence required to ensure an effective programme. A summary of the consultation feedback has also been published.
Update on diabetes prevention programme
NHS England and PHE are starting a major national initiative to prevent illness by unveiling the first ever at-scale National NHS diabetes prevention programme. The programme, which is a joint initiative between NHS England, PHE and Diabetes UK, aims to significantly reduce the four million people in England otherwise expected to have type 2 diabetes by 2025.
The new NHS diabetes prevention programme will initially target up to 10,000 people at a high risk of developing type 2 diabetes, with national roll-out thereafter. Seven innovative ‘demonstrator’ sites around the country have been chosen to take part in the initial phase of the programme during which they will see more patients, monitor and test their local programmes help co-design and implement the national programme. They are: Birmingham South and Central CCG, Bradford City CCG, Durham County Council, Herefordshire CCG/LA, Medway CCG/LA, Salford CCG/LA, Southwark and Lambeth Councils and Southwark CCG.
Their local schemes include drives on: weight loss, physical activity, cooking and nutrition, peer support plus telephone and online support from trained professionals. The diabetes ‘demonstrator’ sites will test innovative ways to pinpoint those people who have a high risk of developing type 2 diabetes including, for example, via the NHS Health Check. Further information is available here.
Content review process
As part of the NHS Health Check content review process the programme’s expert scientific and clinical advisory panel (ESCAP) is inviting proposals from organisations on removing, amending or introducing new elements to the programme. This robust content review process will support ESCAP in making evidence-based recommendations to the Department of Health and ministers on possible changes to the programme. You can find more information here.
ESCAP is considering whether the current diabetes filter should be replaced with a validated risk assessment tool. Findings from a recent feasibility study show that following National Institute and Health Care Excellence (NICE) guidance to identify people at high risk using a validated risk tool will decrease the number of people identified at high-risk of diabetes compared to the current approach. However, this study also showed that reducing the threshold to identify people both at medium and high risk using a validated risk tool is more accurate at identifying people at risk.
As NICE recommends only identifying people at high risk ESCAP has agreed that these findings need to be discussed further with NICE officials. As a result ESCAP has agreed to put the proposal to transition to a validated tool on hold. The full feasibility report has now been published.
Quarter four data submission
Following feedback from local commissioners we can confirm that we will be extending the quarter four data return deadline by two weeks. This means that the portal will now close on Thursday 14 May and data will be published on Thursday 11 June.
Celebrating success: a local perspective, NHS Health Check, East of England
The NHS Health Check programme is commissioned by 13 local authorities across the two PHE centres of Anglia and Essex, and South Midlands and Hertfordshire. The commissioners are part of an active and collaborative network where local initiatives and challenges are shared and learned from.
Suffolk County Council has commissioned Enable East to deliver a pilot programme of NHS Health Checks in Suffolk and Waveney with a variety of outreach locations including areas of high deprivation, work places and the community. The main targets are people with diagnosed mental health conditions and learning disabilities, other groups such as the homeless, asylum seekers and members of the travelling community will also be offered a health check as part of the pilot. The local authority has implemented the NHS Health Check widget on the council’s health and wellbeing webpage where people can find out about the programme and view a short video which is available in English, Bengali, Lithuanian, Polish and Portuguese.
Norfolk County Council is running an NHS Health Check awareness-raising campaign called ‘Precious moments’ for the second year running. The key message for the campaign is to look after your health, so you ‘don’t miss out on life’s precious moments’, such as a new baby, graduation, wedding, or a holiday of a lifetime. The campaign was launched by the council’s chairman and a group of fire-fighters who had a health check. The aim is to reach Norfolk residents through digital, radio and bus advertising and posters at petrol stations and convenience stores. View the Precious moments poster here.
Luton Borough Council has commissioned Live Well Luton to deliver NHS Health Checks to hard-to-reach communities where language is a significant barrier. The people offered an NHS Health Check are mainly Bangladeshi, Polish, Urdu-speaking and gypsy communities. Recently Live Well Luton has also started a new work place health check for employees in businesses like Easyjet, Vauxhall and HMRC who are Luton residents.
Northamptonshire County Council has developed a two-phase model for the delivery of NHS Health Checks in 2014-15. This involves having a local enhanced service arrangement with individual GP practices, supplemented by contracts with the three newly formed GP federations to promote collaborative working among practices and to deliver the programme in the community and workplace. The GP federations also target hard-to-reach groups by developing links with local community organisations.