NHS Health Check e-bulletin - November 2020
Professor Jonathan Valabhji
National Clinical Director for Diabetes and Obesity, NHS England and Improvement
The NHS Health Check programme has proved a valuable means by which those at high risk of developing Type 2 diabetes, described as having non-diabetic hyperglycaemia (NDH), are identified. The Healthier You NHS Diabetes Prevention Programme (NHS DPP), launched in April 2016, provides an evidence-based intervention into which those identified with NDH can then be referred to reduce their subsequent risk of developing Type 2 diabetes.
Over 600,000 people have been referred into the NHS DPP, the world’s first country-wide Type 2 diabetes prevention programme. Attendees can be supported to lose weight, to be more physically active, and to adopt better quality nutrition. Early outcomes published in January 2020 in the international peer-reviewed journal Diabetes Care, conclude “reductions in weight and HbA1c compare favourably to those reported in recent meta-analyses of pragmatic studies and suggest likely future reductions in participant type 2 diabetes incidence”.
This year, the challenge of COVID-19 has forced us to make significant changes to the way the programme is delivered; rolling out a fully remote-delivered service and creating a complementary and temporary online self-referral route into the programme via the Diabetes UK’s Know Your Risk tool.
With data showing the increased mortality risk from COVID-19 for those with Type 2 diabetes, we have worked hard to maintain the NHS DPP for those at risk. Separately, we have also launched services to support people living with diabetes where access to care may have been affected.
This World Diabetes Day, we look back on what has been a challenging year but look ahead with optimism. The rapid roll out of remote delivery of the NHS DPP has enabled us to continue to keep the service running throughout the pandemic as well as reach a whole new group of people who would not have necessarily been able to access the programme in its traditional form.
Feedback from participants on the new remote service is positive. Those who thought themselves not to be ‘technologically savvy’ have grown their skills over the summer through video-conferencing with family and have picked up remote sessions with ease. Others told us being at home with more time is the perfect opportunity to make lifestyle changes. We’ve also heard of the perceived advantages of not having to travel to sessions, or for more shy participants, the ability to contribute without feeling self-conscious.
As we continue to adapt to what may be for some time the ‘new normal’, NHS Health Checks will continue to play an important role in identifying those at risk of Type 2 diabetes and in promoting the NHS DPP. I would like to thank you all for your continued support of people at high risk of Type 2 diabetes and wish you and your families well during this time.
Head of Cardiovascular Disease (CVD) Prevention Programme, Public Health England
I’m pleased to be able to announce that the first scientific paper evaluating the NHS Health Check programme using data from 9.5 million people between 2012 and 2017, has now been published in BMJ open. This is a real milestone moment for the programme as this analysis, and those that are to follow, provide us with vital insight into the programme’s impact. Importantly, this first paper shows that:
- There are no discernible differences in NHS Health Check attendees by index of multiple deprivation, and some black and ethnic minority groups at higher risk of cardiovascular disease are more likely to take up the offer of a check.
- The recording of cardiovascular disease risk factors is higher among people attending an NHS Health Check than non-attendees.
- The NHS Health Check is identifying people with, and at risk of, disease: for every four NHS Health Checks one person is found to have a 10-year CVD risk score ≥10%.
- Advice, information and referrals were delivered to over 2.5 million individuals identified with abnormal risk factors.
- Of the 25.9% identified as having a 10-year CVD risk score of ≥ 10%, one in five were prescribed a statin, and this rose to two in five for people with a CVD risk score ≥ 20%.
Professor Riaz Patel will be presenting the findings of this work at our next webinar on the 18 November. I’m also delighted that much of the data used for this analysis can now be interrogated by Local Authority and Clinical Commissioning Group, as NHS Digital has updated the interactive NHS Health Check Dashboard to include metrics on attendance and non-attendance by index of multiple deprivation, as well as risk factor profiles for attendees. This is in addition to the existing metrics on attendees’ and non-attendees’ age, gender and ethnicity. To find out more, register for our dashboard webinar on the 2 December.
In delivering our commitment to keep the evidence on the NHS Health Check programme under review, we have now also published an update to the NHS Health Check evidence review, undertaken by a team from the University of Sunderland and Newcastle University. This work highlights that:
- Higher levels of chronic kidney disease, hypertension, familial hypercholestrolaemia, peripheral vascular disease and Type 2 diabetes are detected in people having a check compared to standard care.
- Lifestyle and clinical follow up is variable. While statin prescribing is higher among attendees overall, prescribing rates remain low compared to what might be expected based on the current National Institute for Health and Care Excellence cardiovascular disease prevention guidance.
- NHS Health Check attendance is associated with a reduction in mean body mass index, smoking, mean systolic and diastolic blood pressure, and total cholesterol after a six-year follow up.
This important new evidence from the review and data analysis is already having an impact in informing the work of PHE’s evidence-based review of the NHS Health Check Programme. The review is a fantastic opportunity to ensure that we act on evidence to evolve the programme in a way that will yield even greater future health benefits. Thank you to all of you who contributed and engaged in the review of the NHS Health Check Programme so far. If you are yet to share your experience, evidence or views then please do join us for one of the November workshops or complete the short online survey. We will also be looking for six areas to work with us to map local barriers and facilitators to behaviour changes across the NHS Health Check pathway.
Finally, over the past few months it has been extremely encouraging to see how local authorities such as East Sussex and Medway, highlighted in the case study section, working with NHS providers are using innovative methods to restart the NHS Health Check service. This is truly inspirational work at a time of continued uncertainty. I wanted to take this opportunity to thank everyone for their enduring commitment to protecting the nation’s health and to encourage areas to use our restart preparation guide to help inform local decisions about service provision.
NHS Health Check Restart Case Studies
Georgina Crossman, Programme Manager, Health Improvement, Medway Council
With the increasing evidence demonstrating links between CVD risk and poorer outcomes from COVID-19, Medway were keen to re-start the programme as soon as possible. It was decided to take a proportionate universalism approach, to target resources where they could have greatest impact. A survey was completed with primary care to establish which GP practices were willing to re-start delivery, and who would need support from the Outreach Team; circumstances differed across the locality. For practices restarting, reassurance was obtained that they were able to do so safely, and an audit was implemented into GP clinical systems to identify the target groups.
Outreach NHS Health Checks are delivered at Medway’s Smokefree Advice Centre which was made COVID-19 secure by: installing sanitising stations, signage, enhanced cleaning and extended appointment times. Additionally, processes for re-start and delivery were detailed in a standard operating procedure (SOP) to ensure staff were fully informed. This had the added benefit of increasing confidence among team members. The SOP includes information on: national guidance, rationale for re-starting, equipment considerations, staff training, invitation and booking processes, triage, a front of house process and the NHS Health Check appointment itself. After six weeks of outreach delivery 203 checks have been completed.
Ross Boseley, Public health improvement specialist, East Sussex County Council
East Sussex NHS Health Check commissioners developed and completed a practice consultation to explore how best to re-launch the NHS Health Check programme in a way which is safe, sensible, flexible and supports practices to deliver the service. This feedback in conjunction with a local commitment to use the programme as an opportunity to address the health inequalities that COVID-19 had exposed has informed the restart delivery model. As a result, the local team is working to align NHS Health Checks with other locally delivered checks such as the annual Learning Disability check, Serious Mental Illness checks and the assessment part of the COVID-19 Black and Minority Ethnic Locally Commissioned Service.
A restart email was sent to all practices outlining the NHS England and Improvement ‘phase 3 letter’ and confirming commissioner support for a slow, flexible restart of the programme which was practice led. This flexible approach to delivery accepted that practices may need to offer the service by offering a short face-to-face appointment for Blood Pressure, Body Mass Index and bloods with a telephone follow up. A digital results booklet was also developed to allow results and advice to be completed over the phone and emailed to the patient. In addition to NHS Health Checks being delivered in practices community checks have restarted and different delivery models are being tested.
To support practices with restarting templates, searches, an eligible ‘patient notice’ and reminder about the ‘business as usual’ resources and support available were issued. Additionally, to ensure a high standard of delivery, online 90-minute ‘restart training’ sessions have been delivered alongside promoting the NHS Health Check ‘E-Mentor E-learning’. Providers have also been supported to re-enrol with a point of care testing external quality assurance scheme.
The Local Medical Committee and Clinical Commissioning Group have been engaged in the development of this work and both staff and patients are being asked for feedback so that the acceptability and effectiveness of these changes can be understood. Some practices have restarted their delivery and reported activity for Q2, others are planning to re-start in April 2021.
Update on PHE’s review of the NHS Health Check Programme
In 2020, The Department of Health and Social Care commissioned Public Health England to undertake a review of the NHS Health Check Programme, which is currently under way. The review will provide evidence-based advice to Ministers on how the NHS Health Check can evolve in the next decade to maximise future benefits of the programme in preventing ill-health and reducing health inequalities.
To ensure the work of the review is led by the evidence, PHE is drawing on multiple sources of information including: existing scientific literature, NHS Health Check data, national and international case studies and expert advice. Expert advice is being gathered by the review Chair, Professor John Deanfield, through conversations with leaders across the system. There are also a number of opportunities for commissioners and providers with NHS Health Check expertise to join workshops – places for November are still available. Commissioners and providers can also share their learning and insight by completing an online survey.
For further information about the Review of the NHS Health Check Programme, visit our website, or get in touch at ReviewofNHSHealthCheck@phe.gov.uk.
Accelerating Detection of Disease - *Continuing to recruit pilot sites*
Accelerating Detection of Disease (ADD) - the UK’s largest ever health research programme - is looking to partner with Local Authorities to pilot the NHS Health Check as a mechanism for recruiting into the ADD programme starting early 2021.
Accelerating Detection of Disease (ADD) is a collaboration between charities, academia, the NHS and life sciences industry to deliver a world-leading research and development platform for early detection and prevention research. The ADD programme aims to build a cohort of 5 million volunteers over the age of 30 by 2024 that truly reflects the UK population. Building this large and diverse cohort will provide researchers from universities, charities, the NHS and companies involved in health research new opportunities to identify differences in how diseases such as dementia, cancer, diabetes, heart disease and stroke begin and progress in people from all types of backgrounds.
For the first phase of the programme, the ADD team are keen to work with approximately 75 GP practices in local authorities across the country to pilot mechanisms for recruiting people into this world leading resource for health research via the NHS Health Check. This piloting work will inform the design of the main study to ensure the process works efficiently in primary care settings.
Professor John Deanfield and Claire Levermore, Director of Operations for the programme delivered a webinar to explain the programme and piloting opportunity. The full recording is now available on the NHS Health Check website .
Please contact Claire.Levermore@eddrpuk.org.uk to discuss becoming one of the pilot areas that will help to establish this world-leading resource for health research.
If there is a high level of interest in taking part in the pilots, the team will aim to work with a selection of practices that supports the goal of recruiting participants who are representative of the UK population. Thank you to all those who have already been in contact.
Cardiovascular Disease (CVD) Prevention Webinar Series
Our CVD webinar series has now restarted, you can subscribe to our webinar mailing list here. Upcoming webinars include:
- First findings from the national NHS Health Check primary care dataset analysis– 18 November 2020, 13:00–14:00. For more information and to book a space click here.
- NHS Health Check Data Dashboard – 01 December 2020, 13:00 – 14:00. For more information and to book a space click here. Please note webinar times are subject to change
You can find the presentations and videos for past webinars here.
Please note webinar times are subject to change.
Recent and forthcoming publications and data
Tanner L, Kenney RPW, Still M, Pearson F, Bhardwaj-Gosling R, NHS Health Check Programme Rapid Review Update, University of Sunderland and Newcastle University, 2020
Zhelev Z, Peters J, Rogers M, Andrews R, McDonald T, Hyde C, Accuracy and validity of HbA1c Point of Care Testing: A review of the scientific evidence and guidelines, University of Exeter, 2020
Atkins L, Stefanidou C, Chadborn T, Thompson K, Michie S, Lorencatto F, Influences on NHS Health Check Behaviours: a systematic review, BMC Public Health, 2020
Patel R, Barnard S, Thompson K, Lagord C, Clegg E, Worrall R, et al. Evaluation of the uptake and delivery of the NHS Health Check programme in England, using primary care data from 9.5 million people: a cross-sectional study, BMJ Open, 2020
NHS Digital, NHS Health Check Programme, Patients Recorded as attending and Not Attending 2012-13 to 2017-18 [cited 2020 Nov 11]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-health-check-programme/2012-13-to-2017-18
Public Health England, Cardiovascular disease, Diabetes and Kidney Disease data profiles [cited 2020 Nov 11] Available from: https://fingertips.phe.org.uk/profile-group/cardiovascular-disease-diabetes-kidney-disease (will be updated on 1 December 2020)
Public Health England, Diabetes Foot Care data profiles [cited 2020 Nov 11] Available from: https://fingertips.phe.org.uk/profile-group/cardiovascular-disease-diabetes-kidney-disease/profile/diabetes-ft