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NHS Health Checks scheme hailed as ‘remarkable success’

The Government’s national vascular disease prevention scheme is proving a ‘remarkable success’ that has prevented at least 2,500 heart attacks and strokes in England over the past five years, according to GP researchers.

They said their national evaluation of the NHS Health Checks scheme, published today in BMJ Open, also showed the NHS Health Checks had also resulted in more cases of hypertension, diabetes and kidney disease being picked up and more referrals for alcohol problems.

However, GP critics said the study merely confirmed the scheme was a ‘waste of money’ and was failing to reach those at high risk who are most likely to benefit from preventative interventions.

The latest national study on the impact of the programme, led by Queen Mary University of London researchers, covered the period from 2009 to 2013.

It showed around 12% of the roughly 1.68m people sent an invite over the first four-year period actually attended for a Health Check.

Only 1.5% of those sent an invite were found to be at high risk of vascular disease on the basis of a QRISK2 score of 20% or higher – and less than one in five of these ended up on a statin, while only 9% was on antihypertensive therapy.

Nonetheless, based on their findings, the team estimated that if one million more people attended the checks from 2010 then ‘2,529 people would avoid a major cardiovascular disease event over a five-year period’ as a result of the scheme.

Lead author Dr John Robson, a GP in Tower Hamlets and clinical lead for the clinical effectiveness programme at Queen Mary University London, told Pulse the figures could be even greater.

He said: ‘These estimates are entirely based on the reductions resulting from drug treatments and take no account of reductions from smoking cessation, or changes in diet and physical activity.

‘So [they] are likely to underestimate the true impact of the NHS Health Check.’

Dr Robson added that uptake ‘remains highly variable’ but said that ‘if all CCGs came up to the level of the best, the current estimate would double to over 5,000 in five years’ and that ‘overall the NHS Health Check programme has been a remarkable success story’.

However, Dr Paul Cundy, a GP in Wimbledon and chair of the GPC’s IT subcommittee, said the study demonstrated how the scheme focused on people at lowest risk: 'The rate of risk factors being identified in the attendees was less than in those refused the invite but attended for other reasons. This is a well-known phenomenon, those most interested in their health, and therefore more likely to be healthier, are more likely to respond to an invite.'

He added: ‘At the moment it’s a waste of money, the money would be better spent if they allowed GPs to use their knowledge of their patients to focus in on only those that are likely to benefit.'

Professor Azeem Majeed, professor of primary care at Imperial College London and chief investigator on previous national evaluations of the scheme, said ‘some of the results’ were ‘encouraging’.

However, he added that uptake ‘at around 49% nationally remains well below the target of 70% that the Department of Health set’ and that ‘greater efforts need to go into developing standardised operating procedures so that the programme is more uniform across the country’.

What is the NHS Health Checks programme?

Richmond House - DH - Department of Health - online

Richmond House - DH - Department of Health - online

Source: Charles Milligan

 

The NHS Health Checks programme, originally set up in 2009, requires GP practices to call in patients aged 40-74 years for a five-yearly check-up of vascular risk factors such as body mass index, blood pressure and cholesterol.

The Department of Health calculated it would be cost-effective it reached 70% coverage of the target population, but the scheme has been beset with problems of poor uptake from the start and despite a re-launch in 2013 is struggled to reach uptake of 50%, while even Government advisors have criticised the age-based approach and called for more targeted screening.

Readers' comments (16)

  • Taking Dr Cundy's point the healthcheck scheme has still doubled the detection rste for T2DM and CKD - both expensive chronic conditions. Here in Peterborough the healthchecks have led to a significant number of cases of Familial Hypercholesterolaemia being diagnosed - something not included in the study but repeated elsewhere, I believe. I have no personal involvement with the scheme but believe that it is better than the comments above suggest.

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  • Steven,

    I think people are not questioning the benefit of diagnosis a potential treatable disease.

    We are questioning the cost effectiveness of it. Remember the pot is finite and the money taken out to roll this out (At least 7m but probably much more when you include preconception meetings, approval for funds, admin to roll them out etc etc) means less available for other service. I think this is local authority funding? In which case more social workers/care home beds to be funded may have allowed appropriate discharges which in turn would have allowed timely T of acutely well - which could have saved more lives (or improved quality of care) than increasing the diagnosis rate by 0.4%.......

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  • I resisted doing these checks for as long as possible but the threat of a neighbouring pharmacy doing them, claiming the money , then referrering everyone to us led us to adopt it.
    So far it has led to duplication of blood tests, long discussions about cholestrol results in patients who have already decided that they don"t want statins based on media reports. Certainly I have not seen any patients from the "hard to reach" groups that we look after. This afternoons surgery I have 2 patients booked in to discuss slightly raised Qrisks in patients who have already had this discussion after opportunistic health promotion advice. The trouble is that this sort of waste is not been recorded and not taken into account in the studies

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  • Ivan Benett

    It's sad, there's no pleasing some people. Even when the evidence is is clear many in these columns just refuse to accept. What can you do? You'll be wanting the evidence that smoking cessation improves outcomes next, statins reduce the risk of MI, BP control prevents strokes especially in people with diabetes, and early identification of retinopathy prevents people going blind.....It must be very tiring to be negative all the time.

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  • I doubt whether many of the people who have made sweeping statements or swear words have read the article. They seem to be just expressing long standing prejudice against the programme which as previously been widely aired. Has anyone got anything material to add? Resources are tight all round but are we really saying that managing previously unidentified hypertension is 'unfunded' work?

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  • To be totally honest, I'm afraid it has not been the GPs who have been laden with the bulk of the "new work" involved here - it has been the Practice Nurses. I have not noticed an increase in my working hours to accommodate the extra work (merely speaking personally) - but then I am well used to squeezing a quart into a pint pot! The screening/health promotion is our job (of course) but what gets squeezed out the other end? Time spent with the bereaved perhaps? Or those with depression? The parent of a child with disabilities? Who knows? Those things that stop care being more than a mere numbers game? Quite possibly. Never mind the quality - feel the width! The patients who attend for these checks tend not to be the ones who need to come in for them, from experience. And, believe me when I say I've done so many of them I've lost count! What I can count easily are the number of times anything has been found as a result of them....

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