The NHS Health Checks approach is not fit for purpose
Leicester GPs achieved the highest uptake in the country, says Dr Azhar Farooqi - but only after the CCG introduced a LES to tailor the programme to local needs
The NHS Health Checks programme was poorly designed. It does not suit the way primary care operates and the way most patients respond to calls for screening, particularly those who are otherwise well.
In Leicester we started with the national scheme but it resulted in abysmal uptake, so we felt we had to do something – we have a very high-risk population, with double the prevalence of diabetes and half again the prevalence of coronary heart disease compared with the overall UK population.
We therefore set up a LES and have been running own version of a Health Checks programme over the past 18 months. We left it completely up to practices how to organise the checks – screening anybody between the age of 40 and 75 years who does not have a pre-existing condition – as they know how their practice works and they know their population best. Practices largely screen opportunistically – in other words when patients come to the surgery for a different problem – and this has been very successful.
LES for success
As a result we have achieved the highest uptake and coverage in the country. Over the past year we carried out almost 30,000 checks out of an eligible population of around 80,000 – and picked up nearly 3,000 patients with a medical problem such as hypertension and diabetes that would otherwise have gone undetected. So it has had about a 10% ‘hit-rate’.
Practices will need to move to a phase where they call people in who do not come to the surgery and again it is up to practices how they organise this. We need to reach another 50,000 of our target eligible population and we would like to do so in the next eighteen months but even if we can get 70% or 80% that would be fantastic. The idea is then practices will continue to do this on a rolling basis. We are also thinking of lowering the younger age limit to 35 years in South Asian groups in future.
As well as being poorly implemented, the national programme had very low funding, whereas we have specific funding for the initial screen and separate payment for second stage requiring the management of patients who are picked up.
The programme is not fit for purpose at the moment and is unlikely to succeed as it stands. CCGs and local community GPs ought to be free to organise their own screening programmes that are more sensitive to local needs and the way their practices operate.
Dr Azhar Farooqi is the chair of Leicester City CCG and a GP in the city.