The current opportunity in the UK to deliver health and economic value from preventive interventions is huge. In 2017, 84% of deaths in the UK were from a cause considered preventable.1 Reducing the burden of non-communicable diseases, heart issues, obesity, smoking, and mental health is now considered to be key to the long-term sustainability of the NHS.
Yet public health activity in primary care still proves extremely difficult to deliver. For example, national uptake of the NHS Health Check programme has only been 35% across England. This is a low figure given more than 75% of patients who are eligible were invited.2
The NHS Health Check programme, when done right, is a powerful method of improving population well-being. For every 1m people that are health checked, the programme can contribute to 9,000 extra years of life and 10,000 QALYS (Quality-Adjusted Life Year) thanks to the numerous diseases that are caught and subsequently treated early.3
Benefits for practices
For GP practices, the potential economic value from the NHS Health Checks is also worth considering. If the 65% of eligible people who don’t attend a health check were to do so, this could represent around £300m of incentive payments that are currently not being paid out. That’s more than £40,000 per practice.
As part of the process of building a software platform to help primary care providers improve uptake, we have worked with many practices and staff to understand what works for them. This has allowed us to spot common themes.
Here are five suggestions that we have seen used to boost uptake of the NHS Health Check in GP practices.
1. Take advantage of opportunistic appointment booking
All staff should be set up to book patients into appointments whenever the opportunity arises. Receptionists should be trained to book in patients eligible for a Health Check then and there if they attend the practice for whatever reason. Practices that do this know that the usual letter invites are easy to ignore or forget. Practices can set up notifications and alerts to flag up to receptionists if patients are eligible for the Health Check.
2.Book patients into an appointment when they first register
Patients are often at their most engaged when registering at a new practice, which makes it a great opportunity to book them in for an NHS Health Check appointment if they are eligible. Explaining the health benefits and importance of the NHS Health Check at this stage, as well as the simplicity of the appointment, goes a long way to reassuring the patients.
Patients don’t book themselves into Health Checks for a variety of reasons: they're too busy, they forget, they don’t understand what it is, or perhaps they previously had a bad experience at an appointment. As their healthcare provider, getting them engaged upon registration can help foster a positive ongoing relationship where they are more likely to book and attend prevention appointments.
3. Use staff time efficiently
Not every practice has a dedicated member of staff, such as an HCA, to focus on invitation. But you can split your list of eligible patients among receptionist staff. This allows them to use any quiet moments for inviting and booking patients into Health Checks.
4. Educate staff on the importance of prevention
Keeping practice staff up to date on preventive health best practice is a good way to actively engage them in their role and the call and recall process. The practices we saw with the highest uptake had a practice manager who understood that prevention was key for the sustainability of general practice and the wider NHS, rather than viewing it as a low-value administrative task.
It’s also important that all staff are ready to convincingly explain to patients why programmes like the NHS Health Check are beneficial, so patients feel fully informed and motivated to attend.
5. Make your communications more engaging
We have extensively studied what makes an individual book an appointment. Research shows that getting someone to perform a behaviour requires three things – the motivation to do it, the ability to do it, and a trigger to signal that it is time to do it.
These can all be optimised individually when inviting patients to Health Check appointments. And, it’s important to do so in your communications.
Letters and text messages act as a trigger to remind the patient to book an appointment, but the content of these is where you can generate motivation.
Using ‘behavioural economics’, including ‘nudge’ theory, works well here. We found that using the words ‘we have appointments reserved for you, please call to choose one that suits you’ in an invitation, rather than just ‘book your appointment’ triggered 30% more patients to respond to an appointment offer. Essentially, the nudge of the word ‘reserved’ led to patients feeling a sense of value, and they felt more obliged to reciprocate by responding to our SMS invite.
These five tips are used to differing degrees by practices I have visited and worked with and they really can help make a difference to uptake of these appointments, which can help improve patient health and boost practice income.
- Hector Smehurst is founder of Appt Health, a specialist patient engagement tool which makes it simple for primary care providers to achieve higher uptake for preventative healthcare appointments.
- ONS. Avoidable mortality in the UK 2017.
- Public Health England. NHS Health Check Data.
- Mytton OT et al. The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study. PLoS Med 15(3): e1002517. https://doi.org/10.1371/journal.pmed.1002517