Evidence shows GPs should back health checks scheme, says NHS cardiovascular lead

GPs should do more to reverse 'suboptimal' uptake of health checks because new evidence challenges key criticisms levelled at the scheme, NHS England's cardiovascular lead has said.

Dr Matt Kearney (Photo: Pete Hill)
Dr Matt Kearney (Photo: Pete Hill)

Despite fears that the NHS Health Check programme only benefits the 'worried well', a review of evidence has found that it targets patients from a range of socioeconomic backgrounds and risk profiles.

It is also associated with a ‘small increase above routine practice’ in disease detection and a 3-4% increase in prescribing of statins.

GP Dr Matt Kearney, national clinical director for cardiovascular disease prevention at NHS England and Public Health England (PHE), told GPonline the two major findings were ‘encouraging’, claiming they challenged some of the biggest criticisms levelled at health checks.

The report, commissioned by PHE and carried out by the University of Cambridge, reviewed 68 studies to assess attendance, delivery and outcomes of the NHS Health Check programme.

The authors said: ‘These findings go against suggestions that those receiving NHS Health Checks are predominantly white British with low cardiovascular risk and from areas of low deprivation.’

Health check

At current rates over a five-year cycle, they will uncover 700,000 people with high 10-year CVD risk as well as 175,000 with hypertension, 35,000 with type 2 diabetes and 11,500 with chronic kidney disease.

But Dr Kearney acknowledged uptake of the scheme remained ‘suboptimal’, with only half (48%) of patients invited taking up the offer, against a target of 75% – the figure used in economic modelling to establish the clinical and cost effectiveness of the programme.

The report found wide variation in the delivery and follow-up patient care, with uptake in 2013 varying from 27% to 53% across the country.

In general, it found uptake was consistently higher in patients on the older end of the spectrum, female patients and those in more deprived populations.

For the scheme to hit targets it must ‘rely on buy-in from the healthcare professionals delivering the NHS Health Checks’, the report warned.

Around 85% of the 1.5m health checks conducted every year take place in general practice, but support has been variable among GPs. In 2013 the RCGP called the health check scheme a 'waste of money.

Prevention

First introduced eight years ago in 2009, the controversial scheme became a mandated public service in 2013, and is offered to everyone aged 40-74 without existing CVD every five years.

PHE says the scheme, underpinned by NICE guidance, provides ‘a significant opportunity’ to directly engage people in a conversation about what they can do to keep themselves healthy and well.

Dr Kearney said increasing uptake was a priority for the scheme going forwards, ‘to maximise the programme’s potential for preventing premature death and disability’.

General practice should also be given more incentives to prescribe statins and antihypertensives in addition to lifestyle advice, Dr Kearney added, in line with NICE guidance.

‘We have a crisis of preventable illness that threatens to break the NHS,’ warned Dr Kearney. ‘We have a responsibility to get better at prevention. If the health check is picking these conditions up, then that can only be a good thing.

‘Some practices are worried about the evidence base – are we just attracting the worried well? Are we finding new conditions? I think this evidence will be very valuable to clinicians, because it shows that yes, it is having an impact and it is worth doing.’

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