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Analysis: 'Health checks are making health inequalities worse'

The Government’s NHS Health Checks scheme was intended to reduce health inequalties, but there is a good chance it is making things worse, says Dr John Ashcroft

NICE previously looked at the best approach to primary prevention for diabetes and concluded we should just call in patients who look to be at high risk in our GP registers.

The plan was to use PC 67 information on GP systems to identify patients at high risk and produce registers. That was in the NSF (National Service Framework), which came out in April 2000. All PCTs were supposed to create registers of high-risk patients, but it never happened - a total failure of primary prevention.

And we need this to be in the QOF - we need registers of high-risk patients, who we put on statins, those who we identify as prediabetic - and they need to be followed up. None of that is happening. Sir Roger Boyle, national director for heart disease and stroke, wanted to put this in the QOF six or seven years ago but he could not get it in.

It is a great shame that this was totally ignored by the Department of Health. We have the world’s best database that we could use, but we totally ignore it and just call everybody in, from age 40 to 75 years. So the 43-year-old woman, who we already know had normal blood pressure and weight and does not smoke, because we recorded it last week, is called in – what a waste of time. Her time, our time and taxpayers money.

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So the process for who we call in is wrong, and then of those we do, only some come in, and then of those we give, for example, statins for high cardiovascular risk only some will continue taking them. All through that process we are effectively selecting patients and the people who end up being treated at the end of that process will be patients who are middle class, so we are probably making health inequalities worse probably makes health inequalities worse. But we don’t know because no one has done any real work on seeing the impact, although it looks like this may be starting

The irony is that the Government wanted to use the NHS Health Checks programme to reduce health inequalities, but the way the DH is rolling it out is increasing them. Here we are, in a total shambles. It is appalling, that none has got a grasp of this - it feels like the way hypertension was managed back in the 1970s.

Dr John Ashcroft is a GP in Derbyshire

Readers' comments (5)

  • I thought the DH was forced to admit 2 years ago that this scheme was dreamt up by Gordon Brown for political reasons rather than being based on medical principles.
    I have been sent one of these letters inviting me to attend a 30 min appointment to have my BP and cholesterol measured. What a total waste of resources

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  • The clinical evidence base is clear.
    The "organised personality" has always accessed such services.
    "Organsation skill" tends to be selected for by education provision and result in better lifetime earnings, so correlates broadly with socio economic classification.
    The chaotic individuals do not currently access healthcare reactively appropriately, and definitely do not access "organised" proactive care.

    Any "organised health promotion" will therfore always miss the chaotic lifestyle group with most illness.
    Unfortunately even if you commision a "disorganised" health promotion activity, BP checks in the pub, "health busses on the streets" the chaotic lifestyle individuals are less likely to continue with beneficial lifestyle measures or medication prescribed.

    The only potential solution is to turn chaotic personalities into organised personalities , or have "organised health advocates" supporting the chaotic lifestyle.
    This sounds too facist for words which is why it will never be implemented despite being the only "logical" conclusion.

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  • As a member of the Imperial College London research team evaluating the NHS Health Checks programme, I can reassure Dr Ashcroft and readers that most published local evaluations show higher uptake of Health Checks in deprived areas, because many PCTs targeted these populations, and our early analyses of national data confirm this- so English primary care is delivering agian! It may turn out to be the first national screening programme to reduce health inequalities. And let's hope we get some evidence-based comments apart from this one.

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  • I think it is very good Programme.
    It has helped us target people who would eventually become Diabetic/hypertensive earlier .
    We have just done 25 patient but it has been helpful to Pt &DR to detect &treat/advise patints

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  • I 2000 I worked for a GP who allowed me to set up a CVD risk program/register and it worked briliantly but I left to take my skills to another practice as the first practice had a nightmare practice manager (personal). Anyway, the second employer dropped the idea after taking me on, thinking they could do all the CVD reviews on prescription update!
    Sadly, 13 years down the line I am now designated to use a "one stop" machine where the CVD risk patient is often already wrongly coded, or they have other lifestyle risks that need incorporating into the CVD review such as kidney and liver risk.

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