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Can Life Checks show patients the light?

New traffic light scheme seen as key lifestyle motivator – but will it work?

By Nigel Praities

New traffic light scheme seen as key lifestyle motivator – but will it work?

Few aspects of general practice are guaranteed to send a GP's heart sinking quite so quickly as having to talk lifestyle with a hardcore smoker or someone who is severely obese.

But the Department of Health is convinced it can succeed where many have failed, in persuading patients to take an active and enthusiastic interest in their health. Its tool is not an intensive programme of screening and education but a simple website, soon to carry a new traffic light rating system for patients' cardiovascular, mental and sexual health.

The new NHS Life Check – which will sit on the department's much-trumpeted NHS Choices site – carries huge expectations, with ministers convinced it offers the key to empowering patients over their health.

But not all GPs are convinced, with some suspecting it will do little other than swamp surgeries with the worried well.

Dr Rupert Jones, a GP in Plymouth, Devon, and a clinical research fellow at Peninsula Medical School, is worried the site will unnecessarily drive patients clutching red light warnings to surgeries.

‘I have concerns about the potential for people to go on to this website and then go and see their GP if they are overweight or smoking. It may just direct a large number of people to primary care,' he warns.

The site comes after the 2005 public consultation Your Health, Your Care, Your Say found more than 70% of people wanted regular health MOTs. It falls short of providing this, and aims instead to chide the public into improving their lifestyles by flagging up problem areas with the red or amber light, or a green ‘OK' rating.

Elise Craft, communications manager for Life Check, says the website will be an important way of empowering patients: ‘Providing for people's health is not just about treating them when they are sick, but also helping them to stay healthy.'

The system will link up with information provided on NHS Choices directing users to local services, such as stop smoking clinics, a health trainer or their GP. Patients will be encouraged to print out their results from the site as the basis for a GP consultation.

A cardiovascular risk calculator is planned for the site, but some have doubts about wheth-er it can reach those most at risk.

Dr John Ashcroft, a GP in Derbyshire and member of the local CHD committee, argues the site is ‘not evidence-based' and that systematic risk screening is more useful than a website at reaching those most in need. ‘Those coming to the site are likely to be motivated already,' he warns.

Dr Peter Stott, a GP in Surrey and former board member of the National Obesity Forum, warns lifestyle interventions only worked if patients want to change. ‘Just putting up a website or telling people to lose weight won't have much effect unless you can increase their motivation.'

He used to run obesity clinics but ‘totally abandoned' them after finding patients were no better off 18 months later.

But experts say the way to engage an online user is to go interactive. A recent Cochrane review found interactive health schemes had ‘largely positive effects' on behavioural and clinical outcomes – although there was a lack of evidence about how to deliver them.

Too simplistic

Dr Robert West, professor of health psychology at UCL and a department adviser, says the new Life Check is a reasonable start, but may be too simplistic to help all patients.

‘The critical thing is, will the department have the commitment to use it as a vehicle for developing the technology of behaviour change and improve it on a year-by-year basis and make it better and better?'

Dr David Haslam, chair of the National Obesity Forum, doubts whether the department has the expertise to produce a motivating site. ‘But there is potential if it is well designed and planned,' he adds.

He stressed that, website or not, people have to genuinely want to change. ‘We can talk to them until we are blue in the face, but they have to be motivated to change.'

Much may rest on how the website is designed. Professor Paul Wallace, a professor of primary care based at the e-Health Unit of UCL, has developed a successful site to help those seeking information about alcohol problems, called www.downyourdrink.com.

He believes the NHS Life Check must be as individually tailored as possible. ‘I think the idea is a very good one,' he says. ‘But simply pasting up information sheets is probably not going to change behaviour.'

npraities@cmpmedica.com

Traffic-light warnings online

• NHS Life Check will be located at NHS Choices www.nhs.uk
• Patients enter information about their smoking, exercise, alcohol use and stress levels
• The site flags up potential problems with a red or amber light, or a green ‘OK' rating
• It will then give information about local health services or refer patients to a health trainer or their GP
• A prototype for teenagers is currently online at
tlc.need2know.co.uk but will be relaunched along with sites for other ages next March

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