NHS Health Check eBulletin

NHS Health Check e-bulletin - July 2018

NHS Health Check e-Bulletin foreword by Professor Steve Powis, NHS England Medical Director

Steve Powis

The NHS Health Check programme is the largest of its kind in the world. Almost 7 million people in England have had the NHS Health Check in the last 5 years, this is a phenomenal achievement by both local government and service providers. As a result, each of these individuals has had the opportunity of a one to one conversation with a health professional focusing on their future health. They have been helped to identify key behavioural risks such as being overweight, physical inactivity, excess alcohol intake and smoking and have been helped to reduce those risks with brief interventions and referral for more intensive support. They have also undergone tests to identify previously undiagnosed high risk conditions such as raised blood pressure, raised cholesterol, chronic kidney disease and diabetes so that they can then be offered evidence based clinical treatments to prevent heart attacks, strokes and other life changing cardiovascular events. And now, the check includes a dementia component with people being offered advice on how to reduce their risk of dementia - "What's good for the heart is good for the brain".

The NHS Health Check is a core element of the NHS getting serious about prevention. And we need to! The 2017 Commonwealth Fund Report showed that the NHS performs well in comparison with other developed countries in equity, access, care processes and efficiency. But we are second to last in terms of health outcomes. Much of this reflects mortality amenable to health care, and more than half of this is due to cardiovascular disease. The message is clear: we could be doing much better in both the treatment and prevention of heart attacks, strokes and other vascular conditions.

Most NHS Health Checks are provided in general practice although significant numbers are offered in pharmacy and other community settings in order to maximise access. Emerging evidence shows that the programme is successfully identifying risk factors and offering behaviour change and clinical interventions. Encouragingly, there is no evidence that the programme is exacerbating health inequalities - indeed uptake is highest in lower socio-economic groups. There is however significant room for improvement, both in uptake (currently 49% but with substantial geographical variation) and in consistency of follow up treatment (statins and antihypertensives) in primary care and intensive lifestyle behaviour change interventions in the community.

This month sees the first NHS Health Check national data extraction using NHS Digital's general practice extraction service (GPES). This exciting development will use anonymised data from across the country to show in detail how the programme is being delivered, what impact it is having on patient outcomes, and how it can be improved.


OPERATIONAL UPDATE, by Professor Jamie Waterall, National Lead for Cardiovascular Disease Prevention & Associate Deputy Chief Nurse,

Jamie Waterall

Last month we published the latest official statistics for the NHS Health Check, which marked the end of the first 5 years of the programme, since commissioning responsibility moved to local government. With over 14 million people having been offered a check but more importantly, almost 7 million people having received a check, we can be certain that this is one of the largest non-communicable disease prevention programmes in the world, systematically targeting the principal behavioural and physiological risk factors driving premature death, ill health and health inequities in England. On behalf of PHE, I would like to thank our amazing NHS Health Check community for making this happen. Because of your leadership, we know that more people are being identified earlier with significant behavioural and physiological risk factors, but more importantly, more people are accessing evidenced based risk reduction interventions to reduce or manage their risk.

The end of the first full five year cycle now provides us with an important benchmark, which we should be aiming to improve upon. Given the significant variation observed across England, with several local authorities such as Bolton, Ealing, Hammersmith and Fulham, Walsall and Westminster all achieving above 80% of their eligible population receiving a check, we know that many areas could improve their coverage during the next 5 years. PHE is committed to supporting this improvement, which is signalled by our Chief Executive, Duncan Selbie establishing a task and finish group to explore what additional support can be provided by PHE and our stakeholders to support local implementation of the NHS Health Check. This will include a new digital exemplar programme, exploring how digital assets could be used to improve delivery of the NHS Health Check.

I am thrilled to advise you that we are working on a new Heart Age test campaign, which will be launched on Tuesday the 4th September. Having already been completed over 1.8 million times, we know that members of the public value the opportunity to access this important information on their future risk of heart disease and stroke.

There will be a variety of creative resources for partners to use including posters, wallet sized cards and leaflets. Printed resources will be available in digital format for internal printing but can also be printed and delivered to partners upon request via the Campaign Resource Centre. There will also be campaign toolkits which include statistics, copy and digital assets to target high risk audiences. For any questions please contact partnerships@phe.gov.uk and to receive updates please sign up to the Campaign Resource Centre newsletter.

Finally, I wanted to draw your attention to a new NICE impact cardiovascular disease prevention resource published last month. I was delighted to have written the commentary for this document, which challenges us to consider if we are systematically implementing NICE guidelines on a number of cardiovascular disease areas such as diagnosing and managing high risk conditions such as atrial fibrillation, hypertension and dyslipidaemia.  

    


We asked some of our top performing local authorities to share their top 3 tips for achieving a high uptake of the NHS Health Check. I’m delighted to share insights from Susan in Lincolnshire and Steve in Leicester.

  Sue Cecconi

Susan Cecconi, Senior Programme Officer Lincolnshire County Council – NHS Health Checks and Primary Care email: sue.cecconi@lincolnshire.gov.uk

  1. NHS Health Check software that searches the eligible population by risk. Practices can see who their target population is, who's had an initial invitation and who needs to be followed up. Training staff to use the software and sharing best practice from high performing practices.
  2. Patient alerts on the GP systems. GPs, nurses, health care assistants and reception staff can book eligible patients in for their assessment when they visit the practice for another appointment (the uptake to this method of invitation was 78% 2017/18).
  3. Monitoring practice performance throughout the year and offering additional support to low performers, assistance with training new members of staff and a target related bonus payment at year end.

 

  Steve Powis

Steve Petrie, Public Health Manager Leicester City Council – email: steve.Petrie@leicester.gov.uk

  1. Engagement with provider: Key to Leicester City’s success has always been that the GPs in the city were engaged right from an early stage and understood the value of the programme. Involve them in key decisions about the programme, take on board feedback, and ensure that they feel invested in the programme.
  2. Focus on checks: Whilst it’s of course important to maintain invites, the focus here in Leicester City has always been around uptake of the check, first and foremost. We’ve made the model more opportunistic here and smoothed the pathway so as to make it as straightforward as possible for the GPs and practice staff to book in patients when they attend a surgery, and have found this has really paid dividends.
  3. Learn from others: We looked to do a marketing campaign about a year ago and before doing had some great advice from our regional group (East Midlands) that helped us decide what we did (and did not) concentrate on. We then fed back our learning to so as to help others. Sign up to the NHS Health Checks forum, check all areas of the site regularly for new materials, and engage with your regional peers and lead. If you’re unsure or have a tricky issue, chances are someone else has come across this previously!

 


Update on the NHS Health Check national data extraction

A number of important developments have taken place in recent weeks on the national NHS Health Check data extraction. These are outlined as follows:

  • the request to extract the data was issued to general practice
  • notifications and all necessary documentation was published
  • general practice has shown a very high participation rate, and PHE will be able to confirm numbers in due course
  • three of the four GP IT system suppliers have ‘certified’ for the extract (which means that the extraction is ready to take place through those systems), while the fourth has nearly completed certification
  • owing to delays in certification, the dates for the extraction have been modified, but are expected to take place in July 2018
  • the data extract successfully passed through the Independent Group Advising on the Release of Data (IGARD), which will allow the data to move from NHS Digital to PHE.  

CVD Prevention webinar series

We continue to run our CVD Prevention Webinar series and you can follow upcoming webinars on our website: https://www.healthcheck.nhs.uk/commissioners_and_providers/events/webinars/

You can also access recordings and presentations of previous webinars via this link. Recent topics have included;


An update for the NHS Health Check digital exemplar project

Following on from our May update, Public Health England are leading a series of 8 high profile exemplar projects one of which is the NHS Digital Health Check.  We are excited to report progress on the project.

How will this work?

The project is following the guidelines set out by Government Digital Service (GDS) for developing digital interventions. All government digital interventions are required to follow the GDS protocol. https://www.gov.uk/government/organisations/government-digital-service

  • This starts with a discovery phase to ensure that any solution is truly based on the evidence and the needs of the individual, this aims to understand the behaviours of, needs of, issues for, key stakeholder groups, in this case: service users (the eligible population), the service providers, the commissioners/local decision makers.
  • Once the needs of these groups are understood the work stream moves into an alpha phase, this identifies solutions, including looking at the evidence and existing practice, prototype solutions are built and tested with recipients.
  • The final stage before going live is the beta phase, this takes forward a solution to product development.
  • Live is when the final product is rolled out.

The project is following an agile process, to learn more about agile https://www.gov.uk/service-manual/agile-delivery .The CVD prevention team, the behavioural insight team and the digital team at PHE have come together to deliver this project.

What is happening?

The project started with a discovery phase back in March, this focused on service user needs with some input from service providers and commissioners. This provided very rich insight. However, it became apparent during this, that additional insight work was needed. As such a further discovery 2.0 phase will shortly be commencing.

At this stage we are not making any assumptions as to what the solution or area of focus will be going forward. We are starting very much with understanding the needs of key stakeholder groups (service users, the service providers, the commissioners/local decision makers) at all stages of the care pathway including:

  • population level awareness
  • invitation to the check
  • appointment booking
  • delivery of the NHS Health Check (tests, assessment, risk communication, brief intervention, referral) and
  • follow up (lifestyle behaviour change, clinical management)   

How can I get involved?

We are particularly keen to hear about any existing digital technology being used to support the delivery of NHS Health Check in your area, and your experiences of this, or if you are in the process of planning or developing any digital interventions please do also let us know. Please do email us with details at nhshealthchecks.mailbox@phe.gov.uk

Our external provider will be consulting with stakeholders and we will advertise opportunities to be involved in this through PHE centre leads. These are likely to take place late summer/early autumn.

Creation of system leadership forum

The National Cardiovascular Disease Prevention System Leadership Forum

In 2018, 30 organisational partners have come together to form the National Cardiovascular Disease Prevention System Leadership Forum (CVD SLF). The CVD SLF focusses on addressing three major risk factors for CVD – atrial fibrillation (AF), blood pressure and cholesterol. Convened by PHE, forum members include clinical colleges, the third sector, government, arm’s length bodies, academia and clinical experts.

The CVD SLF serves as a senior advisory forum for collective work on CVD prevention, providing a platform for members to align priorities and work collaboratively to provide system leadership on CVD prevention. As part of this work, the CVD SLF is looking to establish collective ambitions on AF, blood pressure and cholesterol, to reduce the risk of CVD in the population. The forum is aiming to publish ambitions by 2019, as well as outlining work taking place across member organisations to help meet these ambitions.

Collaborating to improve outcomes in cardiovascular disease

The Five Year Forward View Cardiovascular Disease (CVD) Prevention Project is a collaborative initiative led by PHE working with NHS England, including NHS RightCare, as system partners. The year-long programme will work towards engaging and influencing local health economies to prioritise atrial fibrillation, high blood pressure and hyperlipidaemia. The Size of the Prize work has shown that increased diagnosis and optimal management of these three high risk conditions produces the greatest return on investment.

So, what are the anticipated outcomes from this initial year-long programme? The long term outcomes include a more sustainable NHS and health and social care savings through the reduction of premature deaths and morbidity associated with heart attacks and strokes. The programme has a clear focus on reduction of health inequalities, addressing the disproportionate variation in CVD outcomes.

The short to medium term outcomes are around the reduction in individual risk factor levels including inequality, for the identified three high risk conditions. This will be achieved through an increase in:

  • number of diagnosis
  • total prescribing of anticoagulants, antihypertensives, statins,
  • total number of patients treated optimally.

The programme is underpinned by collaborative working and sustainable local networks and governance structures, identified clinical leadership and communities of practice, to achieve a more effective and efficient service delivery.

For further information on the project, please contact lori.atim@phe.gov.uk

 


2019 CVD prevention conference save the date  

The 2019 CVD prevention at scale conference will be held on Thursday 14th February in Manchester.

Further details on, what promises to be, THE most informative and inspiring conference of the year will be circulated shortly, save the date in your diaries now!

Investing in world leading cardiovascular disease prevention

The cardiovascular disease prevention team will be hosting a session at the Public Health England Annual Conference 2018. The session titled ‘Investing in world leading cardiovascular disease prevention’ focuses on ‘the economic case for prevention’ theme. It will explore the economic arguments for investing in CVD prevention at both national and local levels, which will include:

  • demonstration of a new CVD return on investment tool commissioned by PHE and developed by Sheffield University
  • a practical example of how capacity for blood pressure and atrial fibrillation testing across Cheshire and Merseyside, including improving access for hard to reach groups, is being achieved through innovative collaborations with community partners

The session will also feature a panel of eminent speakers, who will lead the discussion of an interactive session covering the economic evidence for CVD prevention and partnership models to advance the case for CVD prevention at the national and local levels.

The content is targeted at a wide audience including PHE staff, local authorities, charities, commissioners and primary care clinicians. We hope that all participants will gain greater understanding of the work that PHE and partners are doing to make the economic case for CVD prevention, and how organisations can translate national policy, ideas and evidence around economics and CVD prevention into practical, local implementation.

For further information please contact hazel.nyamajiyah@phe.gov.uk

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