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Health Checks scheme must be targeted to at-risk patients – if it continues at all

GP contract negotiator Dr Richard Vautrey criticises the scheme

The NHS has been assailed in the past decade by a host of short term, populist policies designed to capture media headlines even if the evidence basis for their implementation is uncertain. 

A classic example is the NHS Health Check scheme. The House of Commons’ Science and Technology Committee reported this week that it should be independently reviewed as is not evidence-based.

But none of this will come as a surprise to the many GPs who have repeatedly questioned the effectiveness of this scheme and have not found the evidence-base for it convincing.

Superficially, the NHS Health Check scheme sounds like a great idea.  What could be wrong with doing simple checks on millions of people in order to pick up cases of diabetes and hypertension, start treatment early and as a result save lives? 

The reality, however, is not so simple.

The scheme would certainly be regarded as a form of screening and yet as today’s report highlights, it has never been evaluated properly by the UK National Screening Committee either before or since its introduction in 2009.

In addition, without a proper randomised controlled trial GPs are left wondering whether the way they currently proactively identify new cases of diabetes and hypertension during their day-to-day work is more or less effective than the NHS Health Check programme.

But despite the questions, the scheme has continued to check large numbers of healthy patients and swallows up time and resources that may be spent in a far better way helping the most vulnerable and those with clear clinical needs.

Wider cost implications

The BMA has been repeatedly warning policymakers that general practice is at risk of being overwhelmed by rising patient demand, falling resources, and a shortage of GPs.

The Government in response says that the NHS faces a £30bn funding crisis and difficult decisions have to be taken to both balance the books and maintain essential services to our patients.

It would be far better to invest the resources from the scheme into core general practice so we could focus on what is really important – offering enough appointments to meet the growing needs of our patients. GPs must put their patients first and can ill-afford the distraction of a scheme that definitely adds to workload but does not clearly deliver benefits.

The BMA has consistently argued that if the scheme is to continue it would be far better to have a targeted approach. By using the experience and skills of GPs and practice nurses it would be perfectly possible to design a better targeted system where we focus our energies and resources towards areas of high deprivation and those populations with a high prevalence for diabetes or heart disease. Let’s leave the worried well alone for a change.

The Science and Technology Committee’s report, which echoes the BMA’s concerns, is a good point at which to review the entire NHS Health Check programme. We should put the needs of patients first and invest as a priority in core general practice.

Whilst the NHS Health Check scheme might superficially seem like the right thing to do, we should not continue blindly with an approach whose evidence base for effectiveness is so controversial.

Dr Richard Vautrey is a GP in Leeds and deputy chair of the General Practitioners’ Committee.

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