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RCGP urges halt to NHS Health Checks until ‘robust evidence’ exists



The RCGP has called for the Government’s flagship vascular disease prevention scheme to be discontinued until there is ‘robust evidence in support of it’.

In a damning report sent to public health chiefs, the RCGP said the NHS Health Checks ‘should not be continued’ and called on the Government to commission an independent review by experts from the UK National Screening Committee (UK NSC).

However, experts in charge of the programme dismissed the call, claiming the Department of Health had already ruled out any UK NSC involvement.

The Health Check programme was originally introduced in 2009 and aims to give all adults aged 40-74 a five-yearly cardiovascular risk assessment, but has been dogged by criticisms ever since, with leading GPs warning it leads to overtreatment and primary care resources being diverted to the ‘worried well’ and several studies demonstrating poor uptake and that it fails to identify those people most at risk from heart disease.

Despite the criticisms, Public Health England relaunched the programme in 2013 with a commitment to reach an estimated 15 million eligible people in the population over the next five years, and began a programme of work to apply ‘greater rigour’ in evaluating it – including a consultation on ‘priorities for research’.

The RCGP’s response to the consultation – prepared by the College’s standing group on overtreatment and overdiagnosis and now published on the College website – claims Public Health England is ignoring evidence that continuing the programme at all may be doing more harm than good, while pursuing research that assumes it will be successful.

The report, published on the RCGP website, states: ‘The Health Checks programme has been mandated for some time, in the “absence of direct randomised controlled trials to guide it” – in the words of PHE.

‘Despite the evidence showing that this type of intervention… does not work, the programme of research does not acknowledge this. Public Health England is proposing further research that assumes the programme will work.’

It adds: ‘The programme should not be continued without robust evidence in support of it it. PHE should seek governmental approval to search for high quality evidence nof mortality and morbidity benefit… and seek assurances that the programme can be disbanded on the basis of evidence.’

The report goes on to cite the Commons Science and Technology Committee’s conclusion that the UK NSC should have been asked to review NHS Health Checks, and says the RCGP ‘supports the need for the independent expertise of the UK NSC to be involved in reviewing the current status and research needs of the programme’.

PHE did not comment on the specific criticisms outlined by the RCGP response but in its official response to feedback on the consultation, it said the government ‘has now published a response to the Commons Science and Technology Committee, confirming that the role of the NHS Health Check programme’s expert clinical and scientific panel is to keep the programme’s content under review’.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said the GPC ‘fully supported’ the RCGP response and had raised similar concerns about the scheme, which he said was wasting public money.

Dr Green said: ‘The GPC fully supports the RCGP in their comments about this scheme, having raised similar concerns about the lack of an evidence base with NHS Health Checks directly, to which we have not received an adequate answer.

‘The argument that “as each part is based on NICE guidance then the exercise must be worthwhile as a whole”, which is the best that has been offered so far, is no justification for the spending of vast amounts of public money at  a time of austerity when the existing evidence is that health outcomes are not improved.’

In a statement to Pulse, Professor Kevin Fenton, Executive Director of Health and Wellbeing, Public Health England said: ‘There is clear evidence that key risk factors, such as smoking, and high blood pressure are leading to people developing preventable illness and premature death. This is not only devastating to those affected but is also a huge burden on NHS and social care services.

‘PHE is committed to bringing greater scientific oversight to the NHS Health Check programme and established the Expert Scientific and Clinical Advisory Panel (ESCAP) to review emerging evidence and to inform future policy and programme developments. Two national evaluations of the NHS Health Check will be reported on shortly and ESCAP will review these when available.’