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

Abstract

ObjectivesTo describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England.DesignObservational study.SettingNational primary care data extracted directly by NHS Digital from 90% of general practices (GP) in England.ParticipantsIndividuals aged 40–74 years, invited to or completing a NHSHC between 2012 and 2017, defined using primary care Read codes.InterventionThe NHSHC, a structured assessment of non-communicable disease risk factors and 10-year cardiovascular disease (CVD) risk, with recommendations for behavioural change support and therapeutic interventions.ResultsDuring the 5-year cycle, 9 694 979 individuals were offered an NHSHC and 5 102 758 (52.6%) took up the offer. There was geographical variation in uptake between local authorities across England ranging from 25.1% to 84.7%. Invitation methods changed over time to incorporate greater digitalisation, opportunistic delivery and delivery by third-party providers.The population offered an NHSHC resembled the English population in ethnicity and deprivation characteristics. Attendees were more likely to be older and women, but were similar in terms of ethnicity and deprivation, compared with non-attendees. Among attendees, risk factor prevalence reflected population survey estimates for England. Where a CVD risk score was documented, 25.9% had a 10-year CVD risk ≥10%, of which 20.3% were prescribed a statin. Advice, information and referrals were coded as delivered to over 2.5 million individuals identified to have risk factors.ConclusionThis national analysis of the NHSHC programme, using primary care data from over 9.5 million individuals offered a check, reveals an uptake rate of over 50% and no significant evidence of inequity by ethnicity or deprivation. To maximise the anticipated value of the NHSHC, we suggest continued action is needed to invite more eligible people for a check, reduce geographical variation in uptake, prioritise engagement with non-attendees and promote greater use of evidence-based interventions especially where risk is identified.

NHS Health Check programme: a protocol for a realist review

“…Although national uptake rates generally increased over this period, there was significant regional variation, with uptake rates calculated for upper-tier LA areas ranging from 25.1% to 84.7%. 8 These findings are in line with previous analyses that have identified significant variation in invitation and uptake rate for the programme, 9 and variation in Health Check delivery and follow-up, including referrals to lifestyle services. 10 11 At present, minimal national data exist to explain these differences, yet it is important to determine what does work, for whom and in what setting.…”

“…7 The largest and most recently published analysis of national data relating to the programme found that almost 10 million eligible people were offered an NHS Health Check between 2012 and 2017. 8 Of these, 52.6% (just over 5 million) took up the offer. Although national uptake rates generally increased over this period, there was significant regional variation, with uptake rates calculated for upper-tier LA areas ranging from 25.1% to 84.7%.…”

NHS Health Checks: an observational study of equity and outcomes 2009–2017

“…27 NHS Digital data on NHS Health Checks 2012-2018, did not include new diagnoses and treatments and statin prescribing was almost twice as high as in this and previous studies, indicating major methodological differences. 28 No socioeconomic difference in attendance was reported, 28 while our study reported a small reduction by deprivation quintile Q1/2 17.9% compared to 16.0% in more deprived quintiles Q4/5. Differences may arise from different deprivation scores or population estimates.…”

Testing a Breast Cancer Prevention and a Multiple Disease Prevention Weight Loss Programme Among Women Within The UK NHS Breast Screening Programme - A Randomised Feasibility Study

“…Women of breast screening age in the UK are also eligible for assessment of CVD and T2D risk assessment as part of the NHS Health Check. Current coverage and outcomes for this programme are sub-optimal as it is mainly opportunistic (12). Recent Public Health England reports estimate that only 49% of adults with raised cholesterol and 57% with hypertension have been identi ed.…”