Exclusive: Future of health checks in doubt

A flagship NHS vascular screening drive is struggling to persuade patients to attend checks and GP leaders warn practices may abandon them due to mounting workload.

Health checks: the aim is to screen patients for their risk of heart disease, stroke, diabetes and kidney disease (science photo library)

Official figures show almost 1m patients ignored a GP’s letter inviting them for an NHS health check between April and December 2012. Uptake fell below a 50% minimum target for the NHS.

By January this year, two-thirds (64%) of PCTs were set to miss a key target to offer screening to 20% of eligible patients in 2012/13.

More than 250,000 patients missed out on an invitation as problems with the scheme’s roll-out continued.

Workload increases
Senior GPs said rising workload after the GP contract overhaul meant it may not be financially viable for some practices to offer the checks. A heart charity warned that if the scheme failed, it could set back the country’s health by a decade.

The NHS Health Check programme aims to screen more than 3m people aged 40-74 for their risk of heart disease, stroke, diabetes and kidney disease each year, mostly by invitation from GPs.

But its early phases were beset by problems over funding and confusion about the tests required. Many PCTs – now replaced by CCGs – failed to organise the mass roll-out.

GPC negotiator Dr Chaand Nagpaul said practices had struggled with the logistics of offering so many checks, and this may become even harder in light of growing workload.

‘There’s no doubt that a real challenge for this coming year is practices will be overstretched,’ he said. ‘Whether they have the capacity and inclination to do health checks will be a matter for individual practices.

‘Practices will need to make financial decisions on which services they can provide and which are cost-effective. Health checks need to be traded off against other priorities.’

Dr Nagpaul warned ministers not to blame GPs for the programme’s problems. ‘There’s no doubt practices are working extremely hard and it would be wholly inappropriate for them to be blamed for the government loading them with work beyond their means.’

Local authorities took control of commissioning the checks on 1 April. Dr Nagpaul fears this change may lead to further problems. ‘The last thing GPs need is added pressures from a lack of understanding of the way they work and their needs.’

GP expert view:
Dr Terry McCormack, North Yorkshire GP and secretary of the British Hypertension Society

'I am not surprised that primary care organisations missed their targets; they did so as a calculated gamble.

'The checks are of immense importance and will save lives, but I was never convinced the NHS Health Check route was the best way of achieiving a result.

'I think the strategy should be simplified and re-launched.'

In November, a Cochrane review found that vascular checks to uncover undiagnosed long-term conditions do not reduce mortality rates or morbidity.

Professor Mike Kirby, a locum GP in Hertfordshire with an interest in cardiovascular disease, said many GPs are sceptical about the value of the health checks programme.

‘There is evidence of benefit of identifying those at risk of diabetes and offering lifestyle change support,’ he said. But he added that an audit of whether vascular checks had improved the nation’s health was ‘essential to convince the sceptics’.

DH figures show 884,893 checks took place between April and December 2012, far short of the 1.2m expected. Some PCTs’ schemes managed only a few hundred checks (see box).

NHS Cornwall and Isles of Scilly PCT admitted the roll-out of its local programme was a year behind schedule and blamed ‘winter pressures’.

Jules Payne, CEO of Heart UK, said the charity was ‘very concerned’ about the scheme. ‘The NHS Health Check programme is all about prevention, and without these [checks] being delivered to the level required, the health of the nation will take a backward step of 10 years or more.’

A Public Health England spokeswoman said: ‘A review of the early implementation of the programme is in its final stages and we are using the emerging findings to shape our detailed workplan.’

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