The ‘NHS Health Check’

1. The ‘NHS Health Check’ Quick Guide By Alison Springett

2. Vascular disease: impact • Causes 36% of deaths (170,000 pa in England) • Responsible for a fifth of all hospital admissions • Especially in deprived communities and in South Asians (in the UK mortality from CHD is currently 46% higher for men and 51% higher for women of SA origin than in the non-Asian population)

3. The NHS Health Check • A single, universal, integrated check for all aged 40 - 74 • Straightforward questions and simple blood test(s) • Measure risk of diabetes, heart disease, stroke and chronic kidney disease • Set out how to reduce risk / maintain low risk • Offer tailored package of prevention • Repeat check after 5 years • Suitable for a variety of community settings.

4. National Programme Local Delivery • National programme: - set of core tests which are consistently and systematically delivered across the country • Locally delivered: - PCTs decide how best to implement in their areas to broaden coverage and reduce not widen health gaps • Implementation: - phased from 2009/10 (all PCTs expected to be offering some checks this year) - full implementation by 2012/13 (ie. 20% of eligible cohort invited annually)

5. Standardising the Programme 1 • Vascular Risk assessment Handbook (an excellent document!) http://www.screening.nhs.uk/vascular • Skills for health staff competencies (particularly useful for Healthcare assistants or junior nurses) http://www.skillsforhealth.org.uk/~/media/Resource-Library/PDF/Prevention%20First_v3.ashx • Best practice guidance for the risk assessment and management of vascular risk www.dh.gov.uk/nhshealthcheck (worth ordering hard copies as all are large documents)

6. Standardising the Programme 2 • Patient invitation letter http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_097493.doc This document should be downloaded and used to invite patients in for the Health Check. • Patient information leaflet http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_097490 This leaflet can be ordered in bulk from the DH and should be sent with the invitation letter. It is also available in many other languages. Patients should be aware they are having a ‘NHS Health Check’

7. Health check pathway

8. Who do I call in for a Health check? All patients aged between 40 and 74 years without any of the conditions below need to have a health check every 5 years. CHD – Stroke – TIA – Diabetes – Hypertension – CKD – PVD - Palliative You can either: • Prioritise patients by age group (70 – 74 yrs first they will not be offered a check in 5 years time, then 65, 60, 55, 50, 45, 40). You could do this by month / birthday, i.e. everyone who was 40 etc. last month gets an invitation letter. • Or, if you have EMIS (QRISK) you could start with those who have the highest CVD risk score.

9. How to invite • Use the template letter provided and merge from your practice system. (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_097493.doc) • Add in the information leaflet http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_097490 • Is there a total and HDL cholesterol result for the patient within the last year? If not, send a blood request form with the letter and leaflet. Patients should be advised to make an appointment after they have had their bloods done. • BMI >30? Tick fasting plasma glucose on blood form. • BP > 140 / 90? Tick fasting plasma glucose and serum creatinine on blood form. READ code the invitation letter

10. At the appointment 1 • CVD risk needs to be calculated and saved to notes • Discuss this risk with the patient without being alarmist if high. • Explain in terms of relative risk (i.e. 19% is good for a 74 year old but not for a 40 year old).

11. At the appointment 2 • Average 3 BP readings > 140 / 90? Ask patient to come back to the surgery for hypertension assessment. • Cholesterol TC:HDL ratio > 6? Discuss benefits of statins and lifestyle regardless of CVD risk score • Fasting plasma glucose result >6.1? Repeat FPG. If 2nd result >7 add to diabetes register If 2nd result >6.1 but < 7 = Impaired Glucose Regulation. Intensive lifestyle change will help reduce chances of diabetes developing. <6? Normal, lifestyle advice only needed.

12. At the appointment 3 • Work with the patient about how they can reduce their risk. • Offer support for smoking cessation, increased activity and improved diet. • Refer to any appropriate lifestyle interventions / health trainers etc. • Discuss statins etc. with patient if risk >20% READ code any intervention and the Health Check appt. itself ( also READ code if DNA’d )

13. What next? • Patients with a risk of >20% need to be followed up at least annually for review. • Patients with a risk <20 do not need another ‘NHS Health Check’ for 5 years. However, you may want to follow them up sooner for any identified single risk factors (i.e. weight loss, smoking etc. Do not use the ‘NHS Health Check READ code for follow up appts’). • If, during the health check, patients are found with any of the exclusions (most likely Hypertension, CKD or diabetes), they should be added to the QOF register and are excluded from future ‘NHS health checks’

14. Conclusion • READ coding the invitation letter (and any reminder letters), DNAs or opt outs from the patient, as well as the actual ‘NHS Health Check’ will help you identify patients in the future AND make claiming to the PCT much simpler. • If you would like any further support in providing Health Checks please contact: alison.springett@nhs.net