RightCare programme by Dr Matt Kearney, National clinical advisor, PHE
As well as identifying behavioural risk factors, a core objective of the NHS Health Check is to detect high-risk physiological conditions such as hypertension, atrial fibrillation (AF), diabetes, raised cholesterol and chronic kidney disease (CKD). Although we have one of the best primary care systems in the world, these conditions are often diagnosed late. This matters because individuals affected have substantially increased risk of life-changing events such as heart attacks and stroke. In each case, robust evidence shows that early intervention with behaviour change and medical treatment significantly improves outcomes.
The recently published national evaluation of the NHS Health Check provides encouraging early evidence that the programme is helping to plug this gap in primary care: for example, one in 27 attendees had undiagnosed hypertension and one in 110 undiagnosed diabetes.
Over the next few months, further support for detection and management of these high-risk conditions will come from the NHS RightCare programme. RightCare assists local health economies to maximise value by focusing on unwarranted variation. The programme draws on a broad range of metrics to show clinical commissioning groups (CCGs) where to look, what to change and how to change in order to improve value for their populations.
RightCare is currently developing a new cardiovascular disease (CVD) prevention pathway for its work with CCGs. The pathway takes a holistic approach to include the key primary care activities that influence cardiovascular outcomes such as stroke and heart attack - i.e. detection and management of hypertension, AF, high cholesterol, diabetes, nondiabetic hyperglycaemia and CKD. So in CCGs where CVD is identified as a commissioning for value priority area, RightCare will be providing support to improve detection and management of these high-risk conditions. And one of the cross-cutting solutions to late diagnosis and under treatment will be to improve uptake of the NHS Health Check in the local population.