The first major evaluation of the NHS Health Check in England is published today in BMJ Open and provides encouraging evidence about the reach and the impact of the programme.
This large study led by Queen Mary University found the NHS Health Check is effectively identifying and supporting people at risk of developing cardiovascular disease. In addition, a conservative estimate based solely on medical treatment received by those at highest risk suggests that over the first five years of the programme, at least 2,500 people would have avoided a heart attack or stroke.
The NHS Health Check is the first nationwide programme in the world to tackle prevention of heart attacks and strokes by offering a free Check to eligible adults aged 40-74.
The Check provides a personal review of the behavioural factors – such as smoking, inactivity, harmful drinking and obesity – that increase the risk of developing a heart attack or stroke, and offers professional advice and referral to lifestyle services to support behaviour change. It also helps to detect undiagnosed serious conditions such as hypertension, diabetes and chronic kidney disease.
Researchers analysed data from the nationally representative QResearch database. It included 214,000 health checks over four years across 655 GP practices covering a population of 1.7 million eligible people. The study found that attendance was equal across the top four deprivation quintiles and substantially higher in the most deprived, thus showing that the programme is effectively tackling health inequalities.
People having the Check were much more likely to have their major risk factors recorded than those receiving routine care. Referral rates to lifestyle services were twice as high for smokers, three-to-four times as high for people with obesity and six times higher for people with hazardous drinking than for those not receiving the health check.
In addition, the programme also successfully identified:
- a new case of hypertension in every 27 appointments;
- a new case of diabetes in every 110 appointments;
- a new case of chronic kidney disease in every 265 appointments
- One person in eight found to have a 10 year risk of a major cardiovascular incident above 20%.
These detection rates were two-to-three times higher in those who underwent an NHS Health Check than in those who did not.
At the same time, the study shows that there is still room for improvement. The programme so far has been most effective at targeting the older end of the eligible population – those aged over 60 – and more work is needed to encourage uptake among the younger age group of 40 to 60. However, as cardiovascular risk increases with age, this evidence suggests that the programme is effective in identifying and providing an NHS Health Check to those with the highest risk and not just the ‘worried well’.
In addition, the number of eligible people having an NHS Health Check still needs to increase for the programme to reach its full potential. The study found that attendance increased progressively over four years to 30% in 2012.
The most recent annual data from PHE shows that about 48% of all eligible people now attend when invited. PHE is continuing to work with local authorities to help them deliver the programme more effectively and increase the numbers taking up their NHS Health Check.
Finally, only one in five individuals whose 10 year risk of heart attack or stroke was found to exceed 20% subsequently received the NICE recommended statin treatment.
Not everyone will choose to take a statin but this shows there is significant potential to improve outcomes further by ensuring good clinical follow in primary care after the NHS Health Check.
Dr Matt Kearney is a GP in Runcorn and National Clinical Advisor to NHS England and Public Health England
He has practised in the deprived estate of Castlefields, Runcorn since 2000. He work with NHS England and Public Health England involves supporting programmes to improve prevention, early detection and management of cardiovascular disease, diabetes and cancer.
Matt founded and chairs the national Primary Care CVD Leadership Forum. From 2009 to 2013 he worked as clinical and public health advisor to the Department of Health respiratory programme.
He was a member of the NICE Public Health Interventions Advisory Committee from 2005 to 2013. Matt is a Fellow of the Royal College of Physicians and a Fellow of the Royal College of General Practitioners.