Some of the data are consistent with memories being of iatrogenic origin, but other data clearly point to the need for additional explanations.

The 1990 contract for general practitioners in the UK offered incentives for them to organize health promotion clinics and required them to perform 'lifestyle' checkups of their patients every 3 years, despite uncertainty about the impact of such checks on patient health. To address this lack of appropriate evaluation, a follow-up study to assess benefits in terms of patient behaviour and health resulting from the introduction of lifestyle checkups in general practice in a sample of more than 7000 patients aged 30-70 from 18 practices in three FHSA areas (in south London, Surrey and Yorkshire) has been performed. Eighteen per cent of the random sample of patients reported having a health check in the previous year. A full health check comprising measurement of blood pressure, height and weight, urinalysis and questioning about smoking habits, alcohol consumption, exercise, diet and family illnesses had been given to 29% of respondents reporting a health check of any kind. Respondents in less privileged socioeconomic groups were more likely to have had a health check, but less likely to have had a 'full' check. Reactions to the checks were mainly positive; 81% regarded the check as helpful, and only 6% reported it to be worrying and 6% a waste of time. The implications for the new health promotion banding system in the UK are discussed.

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Summary The objective of this study was to describe the variation in provision of health checks and health‐promotion clinics operating under the regulations of the 1990 Contract for general practice in the UK. Eighteen group practices in three Family Health Service Authority (FHSA) areas of England (two in the South West Thames region and one in the Yorkshire region) were selected for the study. The nurses, largely responsible for the implementation of the health checks at these practices, were interviewed using semi‐structured interview schedules. They were asked about age‐groups targeted, means of recruiting patients for clinics, duration of clinic appointments, and procedures carried out in clinics. All practices offered health checks, and 55% had started doing so before introduction of the 1990 Contract. Recruitment for health checks took place in a number of ways: self‐referral (83% of practices); opportunistically in those with coronary heart disease risk factors (78%); opportunistically during attendance for cervical smears (62%); screening in at least one patient group (78%). Blood pressure, height, weight, urinalysis and life‐style advice were included by all practices. Stress management and quit smoking strategies were offered only by a minority of practices. Duration of first health‐check appointment ranged between 15 and 30 minutes. The basic content of health checks, and life‐style advice given appeared consistent between the widely varying practices. However, the resources available for intervention and follow up showed more variation.