Is it time to rethink the NHS Health Check?

As part of Pulse’s investigation into the NHS Health Check, Samantha Field and Jason Strelitz of the Health Foundation ask whether the programme is still fit for purpose

Pulse’s investigation into the NHS Health Check programme is a helpful moment to take stock. It exposes fundamental weaknesses in how England designs, funds and delivers prevention. If the Government is serious about moving from sickness to prevention, it should prompt wider thinking about the programme overall.

The NHS Health Check is vulnerable to system failure on three counts. It is commissioned locally but mandated nationally; it is funded by a public health grant under increasing pressure; and its delivery relies on GPs who are already over capacity. Pulse’s investigation highlights the consequences: nearly half of local authorities (LAs) investigated now impose caps on delivery, making rationing the dominant operating model rather than the exception.

Of course, rationing is nothing new in a resource-constrained system. However, it exposes a deep contradiction in approach. National messaging actively encourages people to take up their NHS Health Check, yet in many places, those who try may find they cannot access it. If we believe the health check is an important, cost-effective intervention for prevention, then it needs to be appropriately funded.

This also exposes the impact of the real-terms cuts to the ringfenced public health grant, which funds the programme. Despite the Government committing to prevention as a priority, the grant was cut by 26% per person in real terms between 2015 and 2025, with the greatest cuts in many of the poorest areas.

Uptake of health checks is already lowest among those with the highest risk, including men, ethnic minority groups and those living in more deprived areas. Unless LAs that are rationing explicitly prioritise these groups, capping delivery disproportionately excludes the very groups the programme was designed to benefit. Rationing without targeting those at highest risk could intensify inequalities and the greatest potential benefits of the programme will not be realised.

The investigation also raises a wider question about the NHS Health Check itself. Numerous evaluations since launch show that while the programme reliably uncovers risk factors, the evidence that this translates into improved outcomes is less consistent. This is largely because follow‑on pathways are weak, the system lacks capacity to act on risks identified, and uptake of health checks among high‑risk groups remains low. This does make the programme vulnerable when budgets tighten.

The fact that only 11% of GPs considered the NHS Health Check ‘very useful’ reflects this structural fragility. It remains unclear whether scepticism stems from the design of the intervention itself, or from its inconsistent delivery and low uptake. Either way, in a time of highly constrained NHS capacity we need to make sure we are funnelling resources into interventions that we truly believe will move the dial on improving people’s health and reducing health inequalities.

So perhaps this is the moment to think about how we deliver the NHS Health Check. A 2021 review of the programme, overseen by Professor John Deanfield, made sensible recommendations across six areas:

• Build sustained engagement of patients in their health not a one-off moment
• Launch a digital service
• Start younger
• Improve participation
• Address more conditions
• Create a learning system

Since then, there have been two significant changes in the wider environment too. The first is a new Government who, recognising that prevention is the key to addressing spiralling healthcare costs, reduced productivity and worsening health outcomes, has committed to putting prevention at the heart of its strategy. This rhetorical shift must be matched by structural reform; and an improved NHS Health Check programme may be a good place to start.

Second, our technological capability has changed dramatically. Advances in genomics, continuous monitoring, and AI‑enabled risk prediction create new possibilities for personalised, proactive prevention. Early pilots of digital health checks demonstrate potential for increasing uptake, but also highlight challenges: notably, digital options have not improved equity and completion of essential clinical measures remains low. The challenge now is to harness the full potential of innovation while ensuring that new models reach those who stand to benefit most.

Giving our population access to meaningful data about their health risks and the means to do something about it, whether through pharmaceutical intervention or supported behaviour change, should be a core function of a modern prevention-oriented system.

But achieving this requires an NHS Health Check programme that is far-reaching and targeted to those who need it most. It also needs to act meaningfully on the information generated. Evidence shows those who undergo the health checks are more likely to be taking secondary prevention medication, what is less clear is whether health checks also create consistent opportunities for lifestyle change or lead to improved outcomes.

The private sector’s rapid expansion into personalised and preventative health demonstrates public demand is there, but private solutions will not shift population-level risk or tackle health inequalities. The NHS, with its scale and reach, is uniquely placed to deliver prevention at meaningful scale.

But this will only be realised if the programme’s purpose is clarified, its evidence base strengthened, its funding secured, and its design fundamentally recalibrated around the people at greatest risk using innovation. Without this, the NHS Health Check programme risks continuing to absorb public health resources without delivering population‑level impact or reducing inequalities.

Samantha Field is a senior fellow (prevention) and Jason Strelitz is assistant director (prevention) of the Healthy Lives Team at the Health Foundation

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.