Foreword by Duncan Selbie, Chief Executive Public Health England and Councillor Izzi Seccombe, Chairman of the LGA’s Community Wellbeing Board
1 April 2018 marked the end of the first full 5 year cycle of the NHS Health Check programme being led by local authorities, with oversight and implementation support from Public Health England (PHE).
Almost seven million people in England have received a check since 2013, and given that two thirds of premature deaths are avoidable, it is clear there is much to celebrate. The NHS Health Check is the largest public health prevention programme in England, providing the only universal mechanism for identifying and managing the top seven risk factors driving the burden of non-communicable disease for our adults between 40 and 74 years of age.
A recent evidence synthesis conducted by Cambridge University demonstrated that the programme is also successfully engaging people with the greatest health needs and so is reaching the right people.
This is unquestionably down to the leadership provided by local authorities commissioning the NHS Health Check for the needs of their residents and, of course, the many providers delivering them.
For the next five years, the Local Government Association (LGA) and PHE have refreshed our commitment to work together so this prevention programme benefits many more millions of people to reduce their risk of preventable death from cancer, heart disease and dementia. The main challenge is to tackle unwarranted variation in people taking up these checks and in ensuring appropriate clinical follow up and these will be the focus of our greatest attention.
We would like to thank everyone involved in this world leading prevention programme. This is a major success story for local government in its statutory duty to improve the health of the people.
Operational update by Associate Professor Jamie Waterall, National Lead for Cardiovascular Disease Prevention and Associate Deputy Chief Nurse
As we prepare to publish the first full five year official statistics data for the NHS Health Check programme, since commissioning responsibility moved to local authorities, I would like to personally thank everyone who has been involved in implementing this world leading prevention programme. There is no question that the NHS Health Check is leading to more people being made aware of but more importantly taking action on the major risk factors driving premature death, ill health and health inequalities across England. The evidence synthesis completed by colleagues at the University of Cambridge and RAND illustrated that the programme is being accessed by deprived communities and high risk groups, which is a major achievement of the public health community who are responsible for the programme at a local level.
As we look forward to the next five years, we need to focus our attention on increasing population coverage of the NHS Health Check and optimising delivery of the evidence-based interventions which follow the check. This is why PHE has been working with partners to focus on the high risk conditions, which are often identified as part of the check, such as hypertension and high cardiovascular risk. Over the last few months, we have been working with colleagues in NHS England, NHS RightCare and beyond to consider how we best support Sustainability and Transformation Partnerships (STPs) to focus their attention on addressing unwarranted variation in the management of these high risk conditions. For example, we know that only 35% of people with hypertension are both diagnosed and treated in line with NICE guidelines. This is in comparison to 65% in Canada. Given that high blood pressure is the leading risk factor for heart attacks and strokes, our performance on this area must improve if we are to reduce avoidable cardiovascular disease (CVD) events. If you would like to find out more about this programme of work, please do speak to your Public Health England (PHE) centre teams, who will be establishing a programme of work for your locality.
As National Lead for the NHS Health Check, I have often questioned if we have done the programme an injustice by initially describing it as a CVD prevention programme. Given that it is focusing on the top 7 behavioural and physiological risk factors driving premature death and ill health, perhaps we would be better to frame this as a non-communicable disease prevention programme. This is something we will be exploring further with our Expert Scientific and Clinical Advisory Panel over coming months.
Many of you will have seen that the NHS Health Check was highlighted in the government’s Remit Letter to PHE, which signals the continued commitment to this prevention programme going forward into the next five years. As such, the agency is developing a detailed programme of support, which builds on what we have been doing to support local implementation over recent years. This will include the development of a new digital work programme, which will explore how digital assets could be used to optimise delivery and outcomes from the NHS Health Check programme. We will also continue to focus our efforts in better understanding local implementation and outcomes, through the development of a national general practice data extraction for the programme, which will take place later this year. What is clear is that we all need to work together to ensure that we make the most of this world leading non-communicable disease prevention programme and PHE is committed in playing our part in this!
Five Year Forward View CVD Prevention Project
This national project presents a unique opportunity to make a difference to CVD outcomes on a large scale. It aims to deliver on PHE’s commitments as set out in the Next steps on the NHS five year forward view, published in March 2017.
The project focuses on increased diagnoses and optimal management for three identified high risk factors; atrial fibrillation, hypertension, and dyslipidaemia. It is a partnership venture with NHS RightCare and other system partners central to the implementation of CVD prevention interventions, with the objective to increase the prioritisation of at least one of these three risk factors by STPs and Clinical Commissioning Groups (CCGs).
The project has six key themes, influencing; using intelligence and data; supporting local areas with their actions on CVD; developing expertise and working collaboratively; evaluation and reporting; and, embedding sustainability of benefits beyond the project lifespan.
This project is funded until 31 March 2019.
For further information please contact lori.atim@phe.gov.uk
NHS Health Check national data extraction
Starting in June 2018, NHS Digital, acting on behalf of Public Health England (PHE), will be collecting information about people who are invited to an NHS Health Check. The information will contain the results of people who did or did not attend. This information will be extracted using the General Practice Extraction Service (GPES) run by NHS Digital. On 4 May, general practice was informed about the extract, with the request for access to the relevant data.
PHE wants to use the information collected in order to monitor access to the NHS Health Check programme for different populations, as well as the number of people in different communities who are attending an NHS Health Check when they are invited. It will also help to measure how well the programme is being run across England and whether it is having an impact on the health of local people. To date, this information has not been collected on a national scale.
The data will also be analysed to inform our partners and other professionals involved in the programme, including the Department of Health and Social Care, commissioners and professional groups who provide NHS Health Checks, such as pharmacists.
For more information on the data extract, see the NHS Health Check website, which includes frequently asked questions for local authorities and general practice, and patient information. For additional information and documentation, also see the NHS Digital landing page.
NHS Health Checks in the workplace, Lancashire Centre Leads
In Lancashire for the last few years we have commissioned a specialist workplace provider called Blue Healthcare to offer NHS Health Checks to the target audience within workplaces.
This is delivered by a small dedicated and well trained team and managed by a highly motivated, passionate and experienced health improvement specialist nurse.
This is very popular and is helping to support the CVD Prevention agenda in the following ways:
- Encouraged smaller workplaces to look at and address employee health and well being
- Convenience for participants means high levels of take up and engagement
- Ease of access - reduced time off for appointments within primary care
- Positive feedback from all venues
- Embraced by human resource and health and safety managers
- Often leads to other health supportive initiatives within workplaces, such as healthy eating, improved physical activity, stop smoking groups
- Likely to reduce sickness absence
- Shows corporate consideration for employees’ welfare
- Opportunity to promote other aspects of health, such as cancer prevention and mental wellbeing
- Excellent uptake from both public and private sector organisations
- Supports GP delivery in areas where capacity and demand is an issue for primary care
- Increases patient choice in that the NHS Health Check can take place during the working day
- Overall, we have poor take up from men aged 40 - 60, compared to women in the same age group. This provider attends many male-dominated workplaces and thus drives up performance in this under-performing cohort
- Allows flexibility of delivery in areas of low uptake through primary care delivery
- Can target areas of higher health inequalities where needed
- Targeting workplaces creates a team mentality in respect of health issues. One company, with high hypertension prevalence among employees, bought a blood pressure (BP) monitor and set up a Blood Pressure Group. Training undertaken on how to measure, and the group meets regularly to measure BP with group exercise to help manage the condition.
Increasing the uptake of NHS Health Checks, Westminster, Hammersmith and Fulham
In Westminster and Hammersmith and Fulham we have worked hard to increase the uptake of NHS Health Checks to help support our residents in improving their own health and well-being. We have achieved this by taking a three pronged approach.
In 2015 we reviewed our programme and made some changes. Our NHS Health Check programme is delivered through primary care primarily by health care assistants. Firstly, we developed a local template within the GP clinical system and the associated reports. Alongside this, we provided all of our practices with point of care testing and also developed a training programme. We also produced promotional materials and guidance on running the programme for practice managers and health care assistants.
The second key action we took was to actively engage with our GP practice teams. This included attending quarterly CCG meetings and GP network meetings to promote the programme. We then visited targeted GP practices identified as needing additional support - training on using the template, equipment and running searches.
The third key element was the payments. We took into account the financial pressures GP practices face, ensuring that practices are well remunerated for the work they deliver. In the beginning we also offered a range of bonus incentive payments to help incentivise the work. We set targets for practices and produced quarterly performance reports, which helped to encourage natural competitiveness.
We also widened the availability of the NHS Health Check programme to help engage our more deprived communities. We commissioned pharmacies in areas of deprivation, as well as health trainers to deliver NHS Health Checks in community settings.
By adopting a wide and inclusive approach to developing the NHS Health Check programme we have significantly increased the number of our residents who take the opportunity to live longer, healthier lives.
For more information on the Westminster and Hammersmith & Fulham NHS Health Check Programme please contact Lisa Brown, Public Health - NHS Health Checks, lbrown4@westminister.gov.uk
The new NHS Health Check Digital Exemplar Project
Public Health England is leading a series of eight high profile exemplar projects. These exemplars will use the latest digital innovation and working practices to improve public health outcomes.
As a key national priority, the NHS Health Check programme is the first of these exemplars to be signed off. It is an incredibly exciting opportunity to use digital tools and service redesign to transform the existing service.
What is happening?
The project is currently in a discovery phase. The objective of this phase is to understand stakeholder needs, such as how people use, commission and deliver the NHS Health Check.
This includes undertaking significant primary and secondary research to understand where digital technology could enhance the NHS Health Check 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)
- Follow up (lifestyle behaviour change, clinical management).
At the end of discovery phase, proposals with the greatest potential will move forward into the Alpha phase, where prototype solutions will be built and tested with recipients in parts of the country. The findings of this phase will then move forward to product and service development in the Beta phase.
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. Please contact: joanne.jones@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.
Joanne Jones, Head of Business Change, PHE Digital