Guest foreword by Professor Ruth Chambers and Professor Zafar Iqbal
We are really pleased to share our experiences in delivering the NHS Health Check to patients in Stoke-on-Trent, as the city has seen some really promising results. Over the last five years we have learnt so much through commissioning and developing this programme. Our views as a GP Clinical Associate of a Clinical Commissioning Group and Consultant in Public Health working in the city of Stoke-on-Trent differ substantively from the recent negativity from some national commentators about the justification of the NHS Health Check Programme.
The city of Stoke-on-Trent is ranked amongst the 20 most deprived local authorities in England. Life expectancy is well below regional and national levels. Stoke-on-Trent faces real health challenges with prevalence for long term conditions such as diabetes, heart disease and hypertension all above the national average. Deaths from heart disease, stroke, cancers; prevalence rates for modifiable risk factors such as smoking and physical inactivity are all well above the national average. Prior to the NHS Health Check starting we set up a Primary Prevention Programme (which later became the NHS Health Checks Programme); initially targeting the patients estimated to be at the highest risk of cardiovascular disease (CVD). We also set up a comprehensive Lifestyle Programme to support patients making positive lifestyle changes. The above brought together primary care, voluntary sector and private sector organisations in supporting our local population to stay healthier for longer.
So far, our results are looking promising. Since 2009 our local general practice teams have delivered more than 30,000 NHS Health Checks (around a 50% uptake rate overall). Preliminary audit data estimates that, from a sample of 39 general practice teams, our NHS Health Check Programme has identified 437 people with previously undiagnosed diabetes, 57 with chronic kidney disease, and 57 with atrial fibrillation. This is as well as those people found to be hypertensive or have impaired glucose tolerance or at least a 20% CVD risk (Framingham, then Q Risk 2 scores). Without the NHS Health Check as a pro-active engagement with these patients it is unclear if they would otherwise have been diagnosed in a timely manner, especially as raised BP and cholesterol levels can often be asymptomatic.
Taking a step back what do we know about the potential benefits of primary prevention? We know that early identification of long term CVD conditions or substantive risks of such health problems, followed by effective management of CVD risk, can improve outcomes for many patients and may even reverse the effects of CVD for example those with impaired glucose tolerance. We know that people in the UK are now more than ever likely to be overweight, drink too much alcohol and have sedentary lifestyles - so what is the potential of the first systematic programme for a population CVD risk assessment in those people aged between 40-74 years old, who are currently believed to be free of CVD?
In Stoke-on-Trent the NHS Health Check programme is an opportunity to address and minimise the health inequalities in our city - not an easy task. As we near the end of the first five year cycle in Stoke-on-Trent, our sights are focused on improving access to the programme by people in most need of this health check; plus improving the consistency and quality of delivery of the NHS Health Check by whoever provides it, to ensure that it helps to motivate patients to address their lifestyle risk factors and engage with medical/lifestyle interventions. For us, this is the crux of this programme: to make a difference to people’s health on a population-wide basis. However, we are only going to find out what difference we have made if we give it more time and try new things in order to make all elements of the programme work.
In future months we are planning to highlight to general practice teams (our main providers of the NHS Health Check) what the NHS Health Check can do for them and their patients; keep things as simple as possible in terms of contracting with providers; plus ensure strong clinical and public health leadership in Stoke-on-Trent. As we progress into the next five year cycle we will continue to learn new ways of how we can improve our NHS Health Checks Programme.
Professor Ruth Chambers & Professor Zafar Iqbal