PCTs have been slowly gearing up to provide NHS Health Checks in England for every 40 to 74-year-old without diabetes, CHD, hypertension, CKD, AF, or who have had a stroke or are receiving palliative care. So the check is for those not already known to have a vascular problem.
There has been lots of debate about whether GPs or pharmacists should do the checks or other private providers. Another issue is funding and to what extent the time, money and effort required will be worthwhile.
The government expects a 75 per cent uptake - and the pressure is on to meet the national deadline to offer the check to everyone who qualifies, by March 2013.
Size of task
Here in Stoke-on-Trent - as elsewhere - this is a mammoth screening task.
Of the 275,000 people registered as patients in Stoke, 113,000 are aged 40 to 74 years old.
As 28,000 are diagnosed with diabetes, CHD, hypertension or CKD stages 3, 4 or 5, that means 85,000 should be offered the check in a five-year period (by March 2013).
Of course it is not just about providing a health check; the checks will lead to something. That is providing medical management for people with newly diagnosed hypertension or diabetes or lifestyle services for people who smoke, are obese or inactive, or drink alcohol excessively.
What we offer
Luckily we had already prioritised primary prevention for patients with a CVD risk ≥20 per cent some years ago. So, we have pre-loaded the Oberoi search system on practice computers, established lifestyle champions in each practice who lead on primary prevention and employed 20 lifestyle coaches.
The coaches agree lifestyle goals and organise free access to Weight Watchers/Slimming World classes, gyms, walking groups and so on while practices continue to provide smoking cessation services.
Practices can provide the health checks, or PCT-employed healthcare assistants can do so in surgery premises. Local enhanced services agreements cover the costs of practice staff time and effort, and hosting the check, and incentivise practices to refer motivated patients to a lifestyle coach and change their lifestyles.
It has been challenging to get primary prevention going, and in 18 months we have invited 7,500 patients across the PCT.
Of these, 3,330 have attended for a health check after three written invitations - an uptake of 44 per cent.
My practice has been trying to speed up the process. We have found drop-in clinics far more successful than the previous patient invites to make an appointment for a primary prevention check. Those required the patient to arrange a fasting blood test before their actual health check.
We have run four drop-in clinics this year in our practice during afternoons and early evenings. A total of 201 patients, a third of those invited, had a health check after receiving a glossy flyer with a personalised letter from the practice. That is nearly twice the number we had screened after a year of sending letter after letter to the 350 other patients we had invited to a primary prevention check.
The first drop-in clinic was really chaotic with five nurses/healthcare assistants processing 81 patients in five hours, and we had to turn others away.
After that we invited fewer patients at a time.
The components of the NHS Health Check include testing cholesterol/HDL (and glucose if indicated), BP, BMI; enquiring about family history, smoking status, ethnicity, physical activity; and other local measures - pulse rate and rhythm and AUDIT C for alcohol intake.
We found one new diabetic; and 36 of the 201 (18 per cent) who attended had raised BP (>150/90mmHg). Healthcare assistants were capable of doing the check and it is not necessary to use practice nurses.
Near patient testing
We have trialled near patient testing too. Then the patient gets their CVD risk calculated at the clinic. This enables the nurse to talk to them about the implications of their risk score and refer them to a lifestyle coach if warranted.
The disadvantages were the costs (consumables were £10/patient for the system we used) and queues of patients. Each test took 10 minutes so that we needed to revert to venous blood sampling for some patients.
It seems obvious that the NHS Health Check should be delivered in GP settings where the nurse can access patients' medical records, input data, start medical management and follow up patients as required.
Also by carrying them out at the surgery, there are no worries either about patient confidentiality or transferring personal information in a reliable way to the patient's medical records.
- Professor Ruth Chambers is a GP in Stoke-on-Trent and honorary professor at Stafford University
Registered patients 275,000
Age group 40 to 74 years 113,000
Already diagnosed with diabetes, CHD, hypertension or CKD stages 3, 4 or 5 28,000
To be offered health check by March 2013 85,000
The NHS Health Check ims to lower the risk of four common but often preventable diseases in the 40 to 74 age group:
The check involves questions and tests - BP, cholesterol, BMI measurement - and personalised advice. Eligible patients should be invited for a check every five years.