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A faulty production line

It's finally time to say yes to Health Checks

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For the past few weeks I have been working flat out implementing NHS Health Checks in my practice. You are probably a bit dubious about the health benefits of this scheme which was first introduced in April 2013 and this fact was hinted at in an article in Pulse earlier this year, NHS Health Checks programme stalling amid poor uptake and critical MPs’ report which suggested the scheme was ‘stalling’.

Is it worth doing? Ignoring the criticisms of the health benefit, either individual or for the population as a whole, then I would say yes.

In the current economic climate a payment of £28 (if you do a fasting blood through your local pathology department) or £25 (with a near patient test) has got to make sense. But be mindful of the window of opportunity - our local area team has said the contract will run until October but with no guarantee for longer.

The scheme is designed to offer eligible patients between the ages of 40 and 74, who are not currently on a vascular register, advice to help prevent the onset of vascular disease and vascular dementia by supporting changes to and management of behavioural and physiological risk factors.

The Health check consists of a basic dataset:

  • Age
  • Gender
  • Smoking status
  • Family History of coronary heart disease
  • Ethnicity
  • Body mass index (BMI)
  • Cholesterol level
  • Blood Pressure
  • Physical activity level
  • Cardiovascular risk score using an appropriate tool such as QRISK2
  • Alcohol Use Disorders Identification Test (AUDIT) score.

Following the assessment, patients can be classified into low risk for cardiovascular disease, moderate risk and high risk. Patients can then be offered appropriate advice depending on their relative risk. 

A fasting glucose test should be offered to patients with a blood pressure >140/90  or a BMI >30. Patients can be signposted to local smoking cessation, weight management and alcohol support services depending on individual risks. 

The payment for the NHS Health Check is £28 per patient. On the face of it this sounds like a good deal but when you factor in staff time and the cost of consumables the payment falls significantly. 

For example, the cost of undertaking an immediate cholesterol check with a machine supplied (for free) is about £2.80 per test as the practice must buy the test strips though there are cheaper machines available.

High-risk patients as identified by the system should be invited in for Health Checks, and this is how we plan to use our spare nurse-led clinic appointments. But any eligible patient may be offered screening and we plan to do this in our surgeries opportunistically too.

Will you be doing the Health Checks too?

Dr Hadrian Moss is a GP in Kettering, Northamptonshire. You can tweet him at @DrHMoss.

Readers' comments (10)

  • This project actually started in 2009 in the North East!

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  • Bye and thanks for all the fish

    Sorry, you are correct, typo!

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  • We have been doing these since they were introduced but have dropped out this year when faced with the council's application form and training requirements. We are being hammered from all sides with changes and extra work - something had to give and we decided this just wasn't worth it.

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  • hopefully you informed the patients that you were wasting their time...for many not just yourself time is money .the scheme is grotesque

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  • We have been paid only £22 per patient since 2009, but it is now dropping to £17 with a national DES . Ther will be a follow up fee with a GP for certain abnormal results if£25. Barely woth it really when all the admin and clinical time costs are taken into consideration. The patients love the attention though

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  • 10.59 anon Try telling them it's a waste of time and see how much they love it then .....ask how many knew they are attracting income by agreeing to the nonsense

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  • utterly appalling stupid non evidence based nonsense wasting more scarce resources and more time wastage encouraging more ignorant populist dr dependency.why has our profession not utterly rejected this madness..we should not allow our 'leaders' to collaborate with this as we know it is profoundly misguided.

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  • So there I was going along quite happily thinking that Health Checks was designed to identify the mass of humanity that never sees their GP but will develop CVD in 10-20 years (not that they'll turn up when invited!); when all along it was an income generation scheme. Now that this has been properly explained, I'm sure the scheme will be much more popular.

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  • If you truly want to make money at this, you need your phlebotomy and nursing team to take up the cudgels. No more letters booking people in, only for them to DNA. Your phlebotomy team have a captive market of people across their doors interested enough in their health to come in for a blood test, now is the time to get them interested in a Health Check too, if eligible. Make them walk to the reception to book in for the clinic, if they don't make it, they were going to DNA the appointment that phlebotomy could have booked themselves.

    Then you get the results through the computer, do the risk calculations, don't do a 20 minute appointment for those with lower risks and who the Specification says you don't have to see again, send these patients a text for them to collect their results from reception.

    Try this method, very useful for those looking overtime, if they can book the patients in, you can pay them the overtime, no bookings, no overtime.

    Stop messing about with regard to the higher risk patients, get these into see their GP, it will have a bigger impact than the HCAs and Nurses will. Just my 2p that seems to have worked reasonable well. 20%+ of eligible patients seen two years in a row so far, next couple of years are going to be harder though.

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  • These health checks shouldn't be undertaken in the GP practice but in the local pharmacy with oversight of the health checks service by the local GP practice. Health checks can be offered to everyone in a local postcode with them visiting the local pharmacy. Those individuals that need further investigation due to health check findings being abnormal would be referred onward to the local GP practice. This saves time and money and focuses the GP's attention on only those individuals with abnormal results.
    Makes perfect sense to me as the pharmacy is under utilized and such health checks for preventative screenings will not encumber the already over burdened GP practice!!!

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