Exclusive: GPs in more than 70 areas told to limit NHS Health Checks

Exclusive GPs could carry out more checks for heart disease and diabetes as part of the NHS Health Check prevention programme but are being limited by caps imposed by local authorities, a Pulse investigation has revealed.

New FOI data gathered by Pulse has uncovered that more than 70 local authorities out of 151 in charge of commissioning the programme declared they are limiting the number of health checks that GP practices can carry out and be reimbursed for every year – and GPs warned this is effectively limiting the number of patients that can access the checks.  

The prevention programme is meant to be open to all adults aged 40 to 74 years old who do not have any pre-existing health conditions – such as stroke, diabetes, kidney disease and certain heart conditions – and patients have been encouraged in national messaging to ‘book with their GP’.  

It was launched in 2009 to ‘reduce ill-health from cardiovascular disease’, and since 2013, local authorities have been responsible for commissioning it, with most checks carried out in GP surgeries. 

The Government has recently announced that the programme will be expanded to include menopause questions, to benefit five million women.  

But a Pulse investigation has found that budgetary pressures faced by local authorities could undermine the programme.

Local authorities have a statutory obligation to invite the whole eligible population for a health check every five years, equating to at least 20% per year – but an analysis of FOI data gathered by Pulse has shown that many local authorities set limits for actual checks that can be carried out.

Of the 72 councils that have declared they impose a cap, 16 are limiting the checks to 20% of the eligible population; while a further 11 have imposed a limit between 10% and 15%. 

The other 45 councils who limit numbers of checks said they have specific limits set for each practice, in many cases to ‘monitor spending against budget throughout the year’. 

The National Audit Office, the public spending watchdog, has previously warned that while 20% of the eligible population is the ‘implied target’ to cover the whole population over five years, only 3% of local authorities ‘were commissioning at that level’.

The service is commissioned by local authorities who choose how to prioritise their public health grant, which is used for NHS Health Checks alongside other services. However, the grant has reduced in real terms from £4.48bn in 2015/16 to £3.53bn in 2023/24 – a 21% decline.

One Warwickshire GP told Pulse: ‘Prevention is an important part of GP care, and it is one of the platforms touted by the current Government, so it seems counterproductive to limit funding for NHS Health Checks.

‘In my surgery, we’ve had a high take-up rate for these checks over the last few years and have run evening and Saturday clinics to accommodate working people. The whole point of a screening test is to catch asymptomatic people, and by not funding NHS Health Checks adequately, we’re missing out on diagnosing people, particularly with diabetes or hyperlipidaemia.’ 

A GP in the North East said: ‘If properly commissioned and funded we could do more. But as it is with sporadic funding and inability to incorporate proficiently into primary care, it will remain as a sporadic check, and not as it should.’  

RCGP chair Professor Victoria Tzortziou Brown said that the limits create ‘uncertainty’ for practices and mean some patients may miss out, while others are left confused about their eligibility.

She also pointed out that the programme ‘has long raised questions’, including about the strength of the evidence for population-level benefit and ‘persistent issues with uptake’, particularly among the groups most at risk of poorer health outcomes.

She told Pulse: ‘The vast majority of NHS Health Checks are delivered by GP practices at a time when workload has grown – and continues to grow – significantly both in terms of volume and complexity, while funding and workforce have not kept up.

‘GPs want to help patients stay well, but preventive programmes must be backed by strong evidence and funded in a way that reflects the reality of delivering interventions on the ground.

‘This includes ensuring that programmes are commissioned and resourced in a way that supports consistent delivery and focuses on those most likely to benefit.’

Councillor Dr Wendy Taylor, chair of the Local Government Association’s health and wellbeing committee, said that local authorities have faced ‘significant funding pressures’ over the past decade, which have impacted their ability to deliver services ‘at the scale originally intended’.

She added: ‘Despite these challenges, councils continue to work closely with local partners, including GP practices, to target health checks to those most at risk and ensure resources are used effectively. We have long called for sustainable investment in public health so councils can expand preventative programmes like NHS Health Checks, which ultimately improve population health and reduce pressure on the health and care sector.’

A Department of Health and Social Care spokesperson said: ‘Over the last five years more than 75% of the eligible population were invited for an NHS Health Check.  We are actively improving this vital programme that catches people at risk of heart disease and stroke early, by developing an online check that people can use at home, at a time and place convenient to them. 

‘We’re also acting to prevent cardiovascular conditions in the first place by tackling smoking and obesity, and through our 10 Year Health Plan we will turn the NHS around by shifting the focus of care from sickness to prevention.’

Read the full investigation into the state of the programme, including analysis on the limits and how they are affecting practices and patient care, here NHS Health Check: at end stage.

You can hear more about our investigation into health checks on our most recent episode of Pulse in Focus: The podcast for GPs. Listen here.