The

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The NHS Health Check

• Quick Guide
• By Alison Springett

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Vascular disease impact

• Causes 36 of deaths (170,000 pa in England)
• Responsible for a fifth of all hospital
  admissions
• Especially in deprived communities and in South
  Asians (in the UK mortality from CHD is currently
  46 higher for men and 51 higher for women of SA
  origin than in the non-Asian population)

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The NHS Health Check

• A single, universal, integrated check for all
  aged 40 - 74
• Straightforward questions and simple blood
  test(s)
• Measure risk of diabetes, heart disease, stroke
  and chronic kidney disease
• Set out how to reduce risk / maintain low risk
• Offer tailored package of prevention
• Repeat check after 5 years
• Suitable for a variety of community settings.

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National Programme Local Delivery

• National programme
• - set of core tests which are consistently and
  systematically delivered across the country
• Locally delivered
• - PCTs decide how best to implement in their
  areas to broaden coverage and reduce not widen
  health gaps
• Implementation
• - phased from 2009/10 (all PCTs expected to be
  offering some checks this year)
• - full implementation by 2012/13 (ie. 20 of
  eligible cohort invited annually)

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Standardising the Programme 1

• Vascular Risk assessment Handbook
• (an excellent document!)
• http//www.screening.nhs.uk/vascular
• Skills for health staff competencies
• (particularly useful for Healthcare assistants
  or junior nurses)
• http//www.skillsforhealth.org.uk//media/Resourc
  e-Library/PDF/Prevention20First_v3.ashx
• Best practice guidance for the risk assessment
  and management of vascular risk
  www.dh.gov.uk/nhshealthcheck
• (worth ordering hard copies as all are large
  documents)

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Standardising the Programme 2

• Patient invitation letter
• http//www.dh.gov.uk/prod_consum_dh/groups/dh_dig
  italassets/_at_dh/_at_en/documents/digitalasset/dh_09749
  3.doc
• This document should be downloaded and used to
  invite patients in for the Health Check.
• Patient information leaflet
• http//www.dh.gov.uk/en/Publicationsandstatistics
  /Publications/DH_097490
• This leaflet can be ordered in bulk from the DH
  and should be sent with the invitation letter.
  It is also available in many other languages.
• Patients should be aware they are having a NHS
  Health Check

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Health check pathway
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Who do I call in for a Health check?

• All patients aged between 40 and 74 years without
  any of the conditions below need to have a health
  check every 5 years.
• CHD Stroke TIA Diabetes Hypertension
  CKD PVD - Palliative
• You can either
• Prioritise patients by age group (70 74 yrs
  first they will not be offered a check in 5 years
  time, then 65, 60, 55, 50, 45, 40). You could do
  this by month / birthday, i.e. everyone who was
  40 etc. last month gets an invitation letter.
• Or, if you have EMIS (QRISK) you could start with
  those who have the highest CVD risk score.

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How to invite

• Use the template letter provided and merge from
  your practice system. (http//www.dh.gov.uk/prod_c
  onsum_dh/groups/dh_digitalassets/_at_dh/_at_en/documents
  /digitalasset/dh_097493.doc)
• Add in the information leaflet
• http//www.dh.gov.uk/en/Publicationsandstatistics
  /Publications/DH_097490
• Is there a total and HDL cholesterol result for
  the patient within the last year?
• If not, send a blood request form with the
  letter and leaflet. Patients should be advised
  to make an appointment after they have had their
  bloods done.
• BMI gt30?
• Tick fasting plasma glucose on blood form.
• BP gt 140 / 90?
• Tick fasting plasma glucose and serum creatinine
  on blood form.
• READ code the invitation letter

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At the appointment 1

• CVD risk needs to be calculated and
• saved to notes
• Discuss this risk with the patient without being
  alarmist if high.
• Explain in terms of relative risk (i.e. 19 is
  good for a 74 year old but not for a 40 year
  old).

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At the appointment 2

• Average 3 BP readings gt 140 / 90?
• Ask patient to come back to the surgery for
  hypertension assessment.
• Cholesterol TCHDL ratio gt 6?
• Discuss benefits of statins and lifestyle
  regardless of CVD risk score
• Fasting plasma glucose result
• gt6.1? Repeat FPG.
• If 2nd result gt7 add to diabetes register
• If 2nd result gt6.1 but lt 7 Impaired Glucose
  Regulation. Intensive lifestyle change will help
  reduce chances of diabetes developing.
• lt6? Normal, lifestyle advice only needed.

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At the appointment 3

• Work with the patient about how they can reduce
  their risk.
• Offer support for smoking cessation, increased
  activity and improved diet.
• Refer to any appropriate lifestyle interventions
  / health trainers etc.
• Discuss statins etc. with patient if risk gt20
• READ code any intervention and the Health Check
  appt. itself

( also READ code if DNAd )
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What next?

• Patients with a risk of gt20 need to be followed
  up at least annually for review.
• Patients with a risk lt20 do not need another NHS
  Health Check for 5 years. However, you may want
  to follow them up sooner for any identified
  single risk factors (i.e. weight loss, smoking
  etc. Do not use the NHS Health Check READ code
  for follow up appts).
• If, during the health check, patients are found
  with any of the exclusions (most likely
  Hypertension, CKD or diabetes), they should be
  added to the QOF register and are excluded from
  future NHS health checks

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Conclusion

• READ coding the invitation letter (and any
  reminder letters), DNAs or opt outs from the
  patient, as well as the actual NHS Health Check
  will help you identify patients in the future AND
  make claiming to the PCT much simpler.
• If you would like any further support in
  providing Health Checks please contact
• alison.springett_at_nhs.net