NHS Health Check e-bulletin - May -2019

Foreword by Professor Stephen Powis, National Medical Director NHS England and Dr Matt Kearney, National Clinical Director, NHS England and Improvement and Public Health England

The NHS Long Term Plan, published in January, announced a bold ambition to prevent 150,000 heart attacks, strokes and cases of dementia over the next ten years. Cardiovascular disease has quite rightly been identified as a national priority because it causes 25% of all deaths in England and can result in life changing disability for those who survive. It is also a major driver of health inequalities, accounting for a quarter of the life expectancy gap between rich and poor.

Delivering this ambition will of course need action on primary prevention, particularly smoking and obesity, but much will also be achieved by optimising the detection and treatment of the high-risk conditions – like atrial fibrillation, high blood pressure and high cholesterol. Treating these conditions is highly effective at preventing cardiovascular disease, but late diagnosis and suboptimal treatment is common. For example, 4 in 10 people with high blood pressure, that’s around 5 million people in England in total, are undiagnosed, and even when diagnosed, 4 in 10 are not treated to target, so they continue to be at increased risk.

The NHS Health Check is a key part of the strategy to prevent heart attacks and strokes at scale because it provides a systematic method of identifying behavioural risk factors and the high-risk conditions in local populations. But of course, identification is not enough - appropriate follow up action is critical if the health check is to have an impact on outcomes - through support for behaviour change and through treatment of conditions like high blood pressure and cholesterol.

Supporting delivery of the Long-Term Plan, the new GP contract is going to transform primary care. Over the next 5 years, there will be 20,000 additional staff such as pharmacists, social prescribers and paramedics. From July this year, all practices will begin working together in primary care networks, each covering a population of about 30-50,000. They will be responsible for delivering services specified in network level contracts, including from 2021, a CVD prevention contract: this will direct and resource networks to optimise the treatment of atrial fibrillation, high blood pressure and high cholesterol in order to drive improved population health.

In the meantime, NHS RightCare has begun to implement the CVD prevention National Priority Initiative in every CCG (focusing on treatment optimisation in the high-risk conditions), and this month NHS England and Improvement launched a pilot scheme across 23 CCGs to test the use of clinical pharmacists in the management of atrial fibrillation.

In addition, NHS England and Improvement is to commission CVDprevent, a new national audit of primary care. This will provide comprehensive real time data to practices and networks so that they can identify and act on the gaps, inequalities and opportunities in treatment of the high-risk conditions.

To support this transformation, Public Health England has recently published new ambitions for the high-risk conditions, setting the benchmarks we should be aiming for in atrial fibrillation, high blood pressure and high cholesterol, if we are to achieve the Long-Term Plan ambition of preventing 150,000 heart attacks and strokes over the next ten years.

Operational update by Professor Jamie Waterall, National Lead for Cardiovascular Disease Prevention and Associate Deputy Chief Nurse .

We’ve had a fantastic start to 2019 with the launch of the joint Public Health England (PHE) NHS England CVD prevention ambitions which received a huge amount of interest across national media and at our annual conference. I’m also really pleased to be able to say that a total of 40 (91%) STPs have committed to prioritise at least one CVD high risk condition; an improvement from the baseline of 19 (43%) in June 2018 with 34 (77%) STPs prioritised high blood pressure, 19 (43%) high cholesterol and 35 (80%) atrial fibrillation.

PHE and partners are continuing to build on this success to deliver the CVD ambitions and commitments in the NHS Long Term Plan and we are excited about the prospect of the forthcoming Green Paper on prevention. The Green paper offers a fantastic opportunity to really demonstrate, on an international stage, England’s commitment and forward thinking on CVD.

Recently, I’ve had the pleasure of meeting and sharing our learning with Australia’s Heart Foundation Chief Executive, John Kelly. In our joint international case study publication with the BHF we highlight the Australian COACH project where nurses deliver telephone based coaching to people at risk of CVD to take action to reduce that risk. Australia are building on that work and have now launched a NHS Health Check style service across the country.

Continuing to learn and improve remains an essential part of PHE’s work on the NHS Health Check programme. The data that has been extracted from primary care systems on people invited to an NHS Health Check is a significant step forward in this journey. With over 11.8 million records it is the largest data set of its kind and offers the prospect of helping us to monitor and evaluate the programme’s impact. Over the coming months we will be hosting four stakeholder events on the data and inviting feedback on our plans to make the information accessible.

In the meantime, we will be publishing the 2018/19 NHS Health Check data reported by Local Authorities on the 18th of June.

All our health

Public Health England has launched new free bite-sized e-learning sessions, developed in partnership with Health Education England, to improve the knowledge, confidence and skills of all health and care professionals in preventing illness, protecting health and promoting wellbeing. The sessions cover some of the biggest issues in public health and they contain signposting to trusted sources of helpful evidence, guidance and support to help professionals embed prevention in their everyday practice. You can access the All Our Health e-learning sessions here.

Revising total eligible population (TEP)

Local authorities wishing to revise their estimates need to submit their revision using the online portal by the 4th of June 2019.

Setting the estimated NHS Health Check total eligible population (TEP) for 2019-20: Figures for 2019/20 TEP have been calculated by PHE using the latest available Office of National Statistics data (mid-2017 ONS resident population estimates) minus the estimated number of people on existing disease registers. Following feedback received from local commissioners and in agreement with PHE Indicator Methodology Review group, the TEP has also been adjusted to remove prisoners serving a sentence of 6 months or more. Local authorities are invited to review the estimates for their area and if not happy with the latest estimates to submit revised figures and evidence for consideration.

Print ready patient information leaflets and booklets

All NHS Health Check patient information leaflets and booklets are now available print ready on the NHS Health Check website. They are accessible in PDF so they can be edited and printed in bulk locally.

NHSHC Leaflet Dementia leaflet

Option to revise previously published quarterly activity data

From April 2019, local authorities can revise their previously published data themselves. This replaces previous protocol where local authorities had to email the national team and ask for amendments to be made. Revisions can only be made when the portal for submission of latest quarterly data is opened.

Note that data from previous financial years cannot be revised.

Upcoming publishing dates for official statistics

The official statistics for NHS Health Check quarterly data will be published on the following dates:

*Year Quarter*	*Portal opens*	*Portal closes*	*Data published online*
2018-19 Q4	01 April 2019	10 May 2019	13 June 2019 at 9:30am
2019-20 Q1	01 July 2019	07 August 2019	3 September 2019 at 9:30 am
2019-20 Q2	01 October 2019	05 November 2019	3 December 2019 at 9:30 am
2019-20 Q3	02 January 2020	First week Feb 2020	3 March 2020 at 9:30 am
2019-20 Q4	01 April 2020	First week June 2020	7 July 2020 at 9:30 am

Free Blood Pressure Training

On-demand Webinar

This training, funded by Health Education England Midlands and East, is now available to all pharmacists and pharmacy team members across England. Whilst primarily targeted at community pharmacy teams, the content is also relevant to healthcare providers in other settings.

The training covers:

blood pressure measurement technique to ensure you can consistently measuring your patient’s blood pressure correctly
lifestyle behaviours that cause high blood pressure and can be adapted to reduce hypertension
health risks of high blood pressure

The webinar lasts about 30 minutes plus an online assessment and opportunity to access related resources. It is compatible with PC, laptop, tablet and mobile devices and accessible at a time convenient to you. All attendees successfully completing the short online multiple-choice assessment can access a certificate which can be used in the future as proof of completion of the training and support CPD and HLP evidence portfolios.

You can access this training by clicking here.

New Research

Findings from a recent study show that inviting people for their NHS Health Check by phone achieves a significantly higher take up than by letter. You can find the full paper here.

For a list of references of recent scientific publications on the NHS Health Check click here.

NHS Health Check redesign webinar

5th of June 13.30-14.30: Jenna Parton from Northamptonshire local authority will be delivering a webinar on their NHS Health Check redesign. Discussing the audit process completed in Northamptonshire around NHS Health Checks, the results and the changes made to the service specifications and programme as a result.

Click here to register for upcoming webinars.

Update of the NHS Health Check Competency Framework

The NHS Health Competency Framework has recently been updated and will be published shortly on the NHS Health Check website. The updated document provides guidance to commissioners and providers on the minimum skills and knowledge required to competently, effectively and safely deliver the NHS Health Check programme.

NHS Health Check Digital Exemplar – call for providers and commissioners

As the PHE NHS Health Check digital exemplar moves into the alpha phase of research, the team are now looking for local commissioners and providers of the programme to support as participants. During this (alpha) research phase we will test early design concepts and prototypes which will explore whether providing digital elements of the NHS Health Check will enhance the offer for end users. If you are interested in finding out more, please complete this short survey.