Debate: Is the NHS Health Check a waste of GP staff time?

As part of our NHS Health Check: At end stage investigation, two GPs debate the value of the prevention programme, discussing whether or not it is a waste of increasingly scarce staff time and resources for GP practices

YES: ‘Evidence shows that health checks divert already scarce GP time away from those with genuine high-risk needs’

As a practising GP and clinical researcher, I regularly confront the tension between what feels proactive – from a public health and policy perspective – and what actually benefits patients. At first glance, the NHS Health Check appears to represent sensible prevention. However, the strongest available evidence does not show meaningful benefits when applied indiscriminately to the general population.

Large systematic reviews of general health checks, encompassing randomised trials of periodic examinations like those in the NHS Health Check, consistently demonstrate no reduction in total mortality, cardiovascular deaths, or major clinical events compared with usual care. A comprehensive Cochrane review analysing 17 trials with over 250,000 participants concluded that health checks have little or no effect on death rates from any cause, cardiovascular disease, or cancer. While such checks may identify more risk factors and lead to additional diagnoses, this does not translate into improved health outcomes.

This finding aligns with core principles for screening programmes outlined by authoritative bodies. Effective population screening requires robust evidence, ideally from well-conducted randomised trials with long-term outcomes, that benefits (such as lives saved or disease prevented) outweigh harms (including overdiagnosis, unnecessary interventions, anxiety, and false reassurance) at an acceptable cost.

In the specific context of the NHS Health Check, official evidence summaries indicate modest gains in recording risk factors and detecting conditions like hypertension and raised cholesterol, alongside increased uptake of some preventive services. However, these do not extend to unequivocal improvements in hard clinical outcomes sufficient to justify the programme’s costs and demands on GP workload.

Proponents of health checks often point to observational data suggesting improved long-term outcomes among attendees. Yet such findings require caution. Observational studies suggesting better long-term outcomes among attendees are prone to selection bias: health-conscious individuals are more likely both to attend checks and to fare well independently of the intervention.

In everyday clinical practice, most adults consult their GP multiple times per year, typically three to four encounters, often for unrelated issues. These routine, patient-initiated visits already enable opportunistic assessment, including blood pressure measurement, clinically indicated blood tests, medication reviews, and lifestyle discussions. I have previously written about how meaningful clinical problems frequently emerge during these interactions, sometimes with issues the patient had not previously recognised.

A dedicated five-yearly health check rarely uncovers novel insights beyond what occurs through well-judged risk assessment in ongoing care, and for many patients it simply duplicates existing activities.

That duplication is not neutral. Invitations, recalls, data entry, exception coding, follow-up blood tests and medication reviews all consume GP, nursing and administrative time. Within a workforce already managing rising multimorbidity and constrained funding, this opportunity cost is material. Every protocol-led check displaces time from complex, symptomatic or high-risk patients, where personalised clinical judgement offers far greater value within the NHS framework.

A further concern is inequality. Although conceived as a universal preventive offer, NHS Health Check uptake is consistently lower among those in the most socioeconomically deprived groups, certain ethnic minorities, and individuals with chaotic lifestyles or limited health literacy, precisely those at highest cardiovascular risk. As a result, the programme risks widening the inverse care law: those most likely to attend are often the ‘worried well,’ while those with the greatest unmet need remain underrepresented.

To be clear, I am not opposed to prevention. Targeted, evidence-based screening remains essential where the evidence supports clear benefit. Yet as currently designed, NHS Health Checks resemble routine blood testing for the sake of activity rather than a data-driven, high-impact preventive strategy. Providing such checks without compelling proof of benefit risks overdiagnosis, unnecessary follow-up investigations, patient anxiety, and the diversion of already scarce GP time away from those with symptoms or genuine high-risk needs.

It is time to refocus UK prevention on high-value, clinically validated interventions and to make better use of every routine consultation for meaningful, contextualised risk assessment, where human judgement continues to outperform a standardised five-yearly checklist.

Dr Edoardo Cervoni is a GP and ENT specialist in Merseyside

NO: ‘Properly funded health checks are an investment in patients’ futures’

You may ask what the point of the NHS Health Check programme is. Offered to those between the ages of 40 and 74 without a pre-existing condition, are we not just using valuable time to check ‘healthy’ people when we could be treating those with disease? There are barely enough hours in the day already as a GP.

But I could not disagree more; there are so many reasons why NHS Health Checks are not a waste of time. If we are serious about prevention, we have to make time for it. One of 10-year-plan’s key strategies is to shift the focus from treating illness to preventing disease. The NHS Health Check enables height, weight, BMI and blood pressure and measurements to be used alongside baseline blood tests including cholesterol and HbA1c. People without any health concerns may not step foot inside a GP surgery for many years; but does that mean they are healthy and disease free?

Millions of people are living with undiagnosed hypertension – a silent condition that carries a very real risk of stroke and heart failure if left untreated. A simple health check could pick this up, enable treatment to be started, and the risks reduced. That is not wasted time; that is prevention in action.

Recently, my practice nurse saw a man in his 40s who was found to have a HbA1c of 93. He had only attended because he was invited for a health check, and is one of many men who are reluctant to seek health advice despite having symptoms. He is now on medication for diabetes, hypertension and high cholesterol. A health check invitation makes it more acceptable to attend before symptoms escalate and disease complications have potentially started. There have been many others with pre-diabetes, raised cholesterol or raised blood pressure who have had conditions detected at an early stage rather than on arrival at A&E with a cardiac event.

The benefits for the individual’s health and the reduction of the burden on the health and care system are huge: reduced appointments; reduced online requests; reduced hospital admissions; and reduced need for support from social care services after a stroke. When you weigh the modest investment of time against the potential to prevent serious illness, it is difficult to argue that NHS Health Checks are anything other than time well spent.

Of course, there will be many health checks where everything is normal, and I can understand how some may see this as a waste of time, therefore. However, I do believe that the other benefits of the NHS Health Check should not be forgotten. As well as increasing awareness of the risk factors for cardiovascular disease and the importance of a healthy lifestyle, health checks are a good time to discuss other health programmes. Patients can also be reminded about breast, cervical and bowel screening programmes. Screening invitations often arrive at a busy time and can easily end up at the bottom of the pile, forgotten. A health check provides an opportunity to revisit those invitations and encourage patients to book – even if they missed the original letter.

Some patients may also divulge other issues to the HCP during the health check, such as mental health issues, housing issues or one of the many other concerns that can impact upon their overall health. They may not be solved during the appointment, but the patient has had the opportunity to raise that issue they had been meaning to mention for ages and can be signposted to the right professional or service. Practice time well spent not a waste of time.

As with any invites we send out, some patients won’t attend their NHS Health Check. But, if the invite makes some of them at least think about their health and check their blood pressure or book that screening test, then that is a start.

In my practice, nurses and HCAs carry out the health checks. Those with issues identified will then be seen by a GP or other relevant service. Our practice has a system for inviting patients and ensuring that the blood tests are done before the appointment. Others may use clinical pharmacists or other appropriately trained ARRs staff. They have potential to be delivered as a PCN and future potential with more joined up IT systems to be delivered by others such as community pharmacy.

I can recognise that the system as it stands does have its faults. As Pulse’s investigation highlighted, funding for health checks is often capped, and less checks are funded than the number of people eligible. It is my main frustration with the programme and is incredibly short-sighted given the huge potential of these checks for improved health outcomes and reduced burden on the health care system. Some practices may continue to offer some checks, but we all know that general practice cannot continue to deliver services without the funding we need to do this.

Proactive care and prevention of course come at a cost and all the health issues we identify in NHS Health Checks need to be managed using practice time and resources which should be properly funded. Health checks may have a cost attached however proactive care is cheaper in the long term and far better for our patients.

The real waste of GP time is dealing with preventable crises that we had the chance to stop. Properly funded NHS Health Checks are not a waste of time; they are an investment in our patients’ futures.

Dr Sarah Dixon is a senior GP partner in Hertfordshire

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.