NHS Health Check e-bulletin - July 2017 edition

Foreword by Professor Gina Radford, Deputy Chief Medical Officer

The NHS Health Check offers a real opportunity to support behaviour change and the earlier detection of risk factors. If we are serious about delivering a radical upgrade in the prevention of cardiovascular disease (CVD) we need to maximise the potential of the NHS Health Check programme.

After cancer, CVD is the leading cause of death and disability due to heart attacks and strokes, peripheral vascular disease and dementia. It is also a major contributor to health inequalities, with death rates three times as high in the poorest communities as in the most affluent areas. Yet CVD and its devastating consequences are also very preventable, through the detection and reduction of common risk factors such as obesity and smoking. That is why is makes sense to take a systematic approach to the prevention of CVD, and the NHS Health Check, alongside NHS RightCare, clinical leadership and effective commissioning, is an important part of this.

It was hugely encouraging to see CVD prevention set out as a priority for the NHS in the  recent delivery plan for the Five Year Forward View. Commitments include improving the detection and treatment of people with atrial fibrillation and introducing clinical pharmacists to help free up general practitioners to support patients to manage high blood pressure earlier and more effectively.

Public Health England (PHE) will also work with local authorities to reach over 2.8 million more people with an NHS Health Check, working with the NHS to identify more people at high risk of CVD.

I welcome recent work by PHE to  review the current evidence on the NHS Health Check programme, which identified a number of actions that will help to take the programme forward. We know from the evidence that the programme is reaching high risk vulnerable groups, but as it continues to grow we must ensure that tackling inequalities remains central.

Reaching more people across the country – with a greater focus on the most disadvantaged people in our communities – requires a collaborative effort from many different parts of the system, from the NHS to local authorities and the statutory sector. Whilst there may be challenges, the potential rewards, in terms of the early detection of those people at risk of CVD, are significant.

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Operational update by Associate Professor Jamie Waterall, National Lead for Cardiovascular Disease Prevention & Associate Deputy Chief Nurse

Earlier this month, we published the latest official statistics on the NHS Health Check programme, which shows that over 11 million people have been invited and over 5.5 million people have received a check since April 2013. This makes the NHS Health Check one of the largest prevention programmes of its kind, supporting people to understand and take action on the top causes of preventable death and ill health in England. I would particularly like to congratulate those areas which continue to work hard to ensure that their local people are able to access the NHS Health Check programme such as Bolton, Newham and Walsall. PHE remains committed to support those local teams who need to make improvements in delivering this important prevention programme. This is particularly important given that we are now in the final year of the current five year cycle, which requires all local authorities to have invited 100% of their eligible population for an NHS Health Check by April 2018. Further information and resources can be found on our programme website.

I am pleased to advise colleagues that PHE is in the process of commissioning a provider to scope out the feasibility of developing a return on investment tool for cardiovascular disease prevention and, if possible, to go on and build the tool. This will allow us to move away from only considering individual risk factors on a disease area to being able to understand how multiple risk factors affect a specific disease area. We will continue to update colleagues on our progress as this work develops over the coming year.

In September we will be launching a new partnership campaign, which will focus on helping people to know their heart health and take action such as getting an NHS Health Check. This will build on our successful collaboration with partners in the production of the on-line Heart Age Tool and One You resources. We will keep you updated on this campaign as work progresses over the coming weeks.

I would like to congratulate the British Heart Foundation (BHF) for their launch of the blood pressure awards programme and to the seven successful bid areas who have received funding so far. We know that there are an estimated 5.5 million people with undiagnosed and untreated high blood pressure in England, which is now the largest single risk factor for coronary heart disease. More information can be found by visiting the BHF website.

After another successful and well attended event in February 2017, we will be hosting our next conference in London on the 8th February 2018. The theme of the conference will be Getting Serious About Cardiovascular Disease Prevention 2018: Reducing Variation and Optimising Care. Please let us know what you would like us to cover in next year’s conference by answering our online poll.

Finally, I would like to advise colleagues that the new minister for public health and primary care is Stephen Brine MP, whose responsibilities will include the NHS Health Check programme. As we have now ended our period of heightened sensitivity, we will be resuming our programme of webinars and updating the NHS Health Check website with new content.

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Promoting the uptake of NHS Health Checks in North Tyneside 

North Tyneside Council, in conjunction with Newcastle City Council and Nexus, have piloted a pop-up NHS Health Checks clinic in a disused shop located at a busy bus and metro interchange.  Over a four day period, 47 commuters received an opportunistic NHS Health Check.  Alongside the pop-up NHS Health Checks clinic, North Tyneside Council ran a month long publicity campaign on public transport that was geographically targeted to reach our least affluent communities in North Tyneside.  The campaign aimed to increase uptake in GP practices.  We are currently evaluating the impact of the pop-up clinic and the campaign.  For further information about either of these initiatives please contact heidi.douglas@northtyneside.gov.uk.

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BHF projects

In 2016, the BHF developed and launched a UK wide funding programme to enable grant recipients to develop and implement into practice community approaches to the testing and detection of high blood pressure and ensure an agreed pathway is in place to facilitate appropriate and timely medical and behaviour change support. The aims of the programme are:

• Increase the detection and management of people who have undiagnosed hypertension

• Increase accessibility to blood pressure testing in wider community settings

• Increase support for patient self-management and self-testing to become routine practice

• Add to the evidence base and implementation into practice

Seven sites were awarded funding totalling just over £700k in March 2017; six sites in England and one in Scotland. In England the sites are:

Haringey Council & Islington Council – London Greenwich Council – London NHS Lambeth Clinical Commissioning Group – London Cheshire and Merseyside Public Health Collaborative – North West Bradford Districts Clinical Commissioning Group – Yorkshire and Humber Leeds City Council – Yorkshire and Humber

The funded sites are carrying out a range of innovative blood pressure projects including community testing in non-medical settings such as places of worship, workplaces and community centres. Some of the projects are making use of the latest digital technology including apps and text messaging systems and several of the projects are focusing on diagnosing hypertension in the community with the aid of ambulatory/home blood pressure monitoring, therefore reducing the burden for primary care.

A second round of funding will be announced later in the summer.

For more information about this programme please contact bloodpressure@bhf.org.uk. 

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National support – local leadership: Tackling the Atrial Fibrillation (AF) challenge through a systems approach

PHE’s AF related stroke prevention programme provides strategic support and leadership to unblock system-wide challenges to help improve the quality of care and outcomes across the AF care pathway.

Over the past year, the programme has successfully strengthened collaboration with Academic Health Science Networks (AHSN), NHS Right Care, the voluntary sector and others to identify key barriers to quality care, scale up good practice and secure AF as a priority. The programme also secured consensus on ‘a call to action’ to prevent 5,000 AF related strokes over the next five years in England. To facilitate achievement, PHE and the AHSN collaborated on the  AF landscape tool and AF  business case model to support commissioners and providers to identify gaps, opportunities for improvement and inform resource allocation across the AF pathway.

One of the objectives of PHEs national AF-related stroke prevention programme is to increase opportunistic detection rates of AF in line with National Cardiovascular Intelligence Network (NCVIN)  prevalence estimates. 68,093 new AF cases were detected in 2015/16 which was likely a result of system-wide action on AF. This increase in detection is estimated to have prevented ~2000 AF-related strokes, with an estimated cost saving of over £40 million across the health and social care economy.

For more information please contact Shakti.dookeran@phe.gov.uk.