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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)

  • Dear All,
    A more detailed analysis.

    They claim all the diagnoses made amongst attendees are “new” and due to the program. But thats not true, new diagnoses were also being picked up amongst those who didn’t attend a NHS Health check but who attended their GP for other reasons – i.e. opportunistic pickup.

    for example they claim;

    1934 new diabetics picked up in those that attended checks (rate of 0.9%) but the rate picked up opportunistically amongst non attenders was 0.4%. So the program only actually resulted in approximately 900 patients being diagnosed (1934 X (0.9 - 0.4)).

    Similar figures for kidney disease; 807 (0.4%) new but 2310 opportunistically (rate 0.2%). So 400 cases CKD that were new diagnoses attributable to the program, not 807.

    If you subtract those that were picked up opportunistically the programs pickup rate is virtually no different from normal GP pickup rates.

    Assume it costs £1 to invite each patient and a very modest £25 for each NHS Check then the program has cost at least £7,029,000. They can reasonably claim to have picked up 6,526 new diagnoses of CKD, diabetes and blood pressure. That’s approx. £1,076 per new diagnosis.

    And this is before we factor in the cost of administering the service and the consequential harms that we know can arise from increasing health anxiety etc.

    “The fundamental flaw in the NHS Health Check program is that it is indiscriminate, it targets everyone, no matter how healthy we already know they are"

    Regards
    Paul C

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  • For the sake of my sanity I have got to stop reading Pulse when constantly faced with sensational click bait headlines which only confirm what we already know about this incompetent bunch!

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  • How does it go....yes lies, damned lies and statistics!

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  • In York the council who are now responsible for commissioning health checks has pulled the plug. More worryingly they have also stopped funding smoking cessation clinics.

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  • Bollox

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  • "All screening does harm." Sir Muir Gray
    I wonder if this screening programme underwent a cost benefit analysis. I suspect the cost was assumed to be negligible and within the envelope of the block GP contract.
    I wonder if this programme passed the screening criteria tests of Wilson & Jungner.
    More likely, it seemed like a vote winner.

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  • 2529 major cardiovascular events could be avoided over a five year period if 1 million more people have the checks. This is the same number of men who died every 30 weeks in the UK from suicide alone. Let's get our priorities right.

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  • It is a success because they managed to get GP practices to do them for peanuts ! Not worth the time or money

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  • Local non-GP providers get £75 not £25 - so quadruple the estimated cost of this scheme - and add in the extra burden to the NHS or repeated tests that the practice has to do to confirm the inaccuracies of the non-GP providers - this is a massive drain and does nothing to help us treat the actual ill as opposed to the worried well who would be better educated on their lifestyle choices anyway !!!!

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  • Think about the additional, unfunded work resulting from the healthcheck.
    Any scheme which encourages patients to squeeze every last drop out of the GP block contract will be seen as positive by our Government.

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