A new review of research published within the first eight years of the NHS Health Check programme has informed next steps for the programme and priorities for future research. The review, carried out by Dr Juliet Usher-Smith and Professor Jonathan Mant with colleagues at the University of Cambridge Primary Care Unit and RAND Europe, is the first comprehensive look at what the evidence says about the NHS Health Checks programme. The review was commissioned by Public Health England’s Expert Scientific and Clinical Advisory Panel to inform its own report, also published on the 8th February 2017, titled ‘NHS Health Check: The latest learnings and priorities for progress’.
The NHS Health Check programme was introduced in England in 2009 aiming to cut risks for developing cardiovascular disease (CVD). This is the largest current prevention initiative in England but it remains controversial. A growing number of published studies describe the NHS Health Check programme and look at its impact over the first eight years. But this is the first independent, comprehensive, review of the evidence, to identify what has been learned about the NHS Health Check programme so far.
The review was guided by six questions, with a particular focus on who attends the NHS Health Check, how the checks are delivered and whether they make a difference to people’s health.
Summary of findings
- The proportion of eligible people who go for an NHS Health Check varies substantially across regions and in different healthcare settings. Older people, women and people from more deprived populations are more likely to have a check and this may reflect targeting by healthcare services. Outreach services in the community can reach particular socio-demographic groups but we need to know more about these services before we can be clear about their value.
- Promising ways to increase the number of people taking up the offer of an NHS Health Check include changes to the way the invitation is written (this delivers a 3-4% increase), and the use of text message invites or reminders (this delivers an increase of up to 9%).
- People who do not take up the offer of an NHS Health Check say that this is due to lack of awareness or knowledge about the checks, competing priorities for their time, misunderstanding the purpose of the checks, not believing in preventive medicine, difficulty getting an appointment with a GP, and concerns about their privacy and the confidentiality of pharmacies. Amongst those that do take up the offer, there are high levels of satisfaction (over 80%). Some said that attendance had acted as a wake-up call and having the check had encouraged them to make lifestyle changes to try to improve their health. Others were left feelings that their expectations were unmet and some were confused about or unable to remember their risk scores. Some said they found the lifestyle advice too simplistic and un-personalised.
- There are wide variations in how NHS Health Checks are delivered across the country, in part because of local differences in how they are organised. Regardless of region or setting, those delivering NHS Health Checks reported challenges with workload, IT, funding, and training. Amongst GPs and those working in GP surgeries there were concerns about inequality of uptake and doubts about the evidence underpinning the programme and the cost-effectiveness.
- NHS Health Checks are associated with small increases in disease detection. There is very little data on whether people do change their behaviour or if referrals to lifestyle services change. NHS Health Checks are associated with a 3-4% increase in prescribing of statins, medications to reduce cardiovascular disease.
This review showed that there is a need for better characterisation of local variations in practice and robust evaluations of the outreach programmes being introduced across the country. Follow-up studies are also needed to quantify the impact of the NHS Health Check programme on practitioner and patient health-related behaviours.
– lead author, Juliet Usher-Smith, Clinical Lecturer, Primary Care Unit
The report of the NHS Health Check Expert Scientific and Clinical Advisory Panel and the review of research by the University of Cambridge and RAND are published here
About Dr Juliet Usher-Smith
About the Prevention Group’s research
About the Cardiovascular Group’s research