Monday 22 December 2014

Provider focus: Delivering NHS Health Checks via GP practice

Having recently revamped their health check service, Bewick Crescent Surgery in County Durham conducted almost six times as many health checks as they had done prior to implementing their new approach; they’re now amongst the top performing practices in the local authority for the delivery of NHS Health Checks. We caught up with Tracy Fleming – the surgery’s NHS Health Check Lead – to find out what the team had done to turn their service around…

Q: What was it about Bewick Crescent’s previous approach to delivering NHS Health Checks that wasn’t working well? 

A: Our doctors were telling people that they needed an NHS Health Check, but we found that people often weren’t turning up to their appointments despite having been booked in. This meant that we were often allotting time that ended up being wasted when patients didn’t attend. We also found however that when patients were in a less formal situation – with the healthcare assistants for example – they would often have the confidence to say ‘well actually I don’t want one’. We saw that taking advantage of this would allow us to be far more efficient with our time and resources.

Q: How did you take advantage of this and alter the service?

A: I’ve taken it upon myself to start asking people as they come in. For example, a patient might feel unwell and come into the surgery for a blood test; if they’re eligible I’ll ask them if they’re interested in having a health check and, if so, book them in there and then. I’ve found you tend to get a much better response when the person is in front of you. For us, it works better than sending out letters that you might not get a reply to

Q: So does Bewick Crescent Surgery not send out invite letters? 

A: We do send invite letters, yes. With those people that we can’t get on the telephone to make an appointment, we send a letter informing them of the service and asking them to ring us if they’d like to book in for a health check. Instead of saying ‘come in at this time on this day’ – which we’ve found doesn’t really work – those that are interested get in touch and those that aren’t don’t ring back. This just allows us to be more efficient and not waste our time with unattended appointments. 

Q: It sounds like efficiencies are at the heart of a lot of the changes? 

A: Yes, that’s true; the fact that I’ve taken a leadership role in delivering the service has made that easier. Patient-centeredness is also really important. We’ve made sure that patients come first and any changes work for them. For example we’ve introduced a Tuesday evening clinic that runs between 5pm and 7.30pm. 

Q: What was the rationale for putting on this out-of-hours service? 

A: We put on the evening clinic to accommodate for those people that wanted to have a health check but who weren’t able to get the time off work during the day. It means that we’re engaging a large number of people that we wouldn’t otherwise get to see. It’s been really well received by patients, as has the quality of the health checks that we’re delivering.

Q: What is it about your health checks that patients appreciate? 

A: Health Options software is a lot nicer and more patient-friendly than the software we used before. I tilt the screen so that I’m not talking at the patients, but instead we go through the process together. They can see what I’m doing – I don’t hide anything – and I use the on-screen info to help explain things to them. In that sense, the computer becomes more of a shared focal point; patients therefore don’t feel as though they’re being spoken at, they’re actively involved in their health check. 

Q: And what do people leave with after their health check? 

A: Everyone gets a colourful personal report in a folder; this is another thing that’s really well received. The reports are full of good information on blood pressure, cholesterol, weight management etc, as well as containing the patient’s results. Often people don’t grasp everything that’s said to them when they come into a doctor’s surgery but with this, they’re able to go home and digest the information at their leisure. The report also contains a graphic that clearly explains the individual’s heart age, cardiovascular risk and the potential effects of lifestyle change. This tends to have a much more powerful impact that just saying ‘stop smoking’ or ‘eat healthily’.

Q: Do you see the health checks having an impact then? 

A: Yes, we’ve had a number of patients take up our smoking cessation service after having had their health check. People are also very interested to learn about the different types of cholesterol – HDL (good) and LDL (bad) – and what they can do about their levels. I’ve found people leaving saying ‘I didn’t realise eating more fruit and veg and stopping smoking could make the difference’. There have also been individuals like a man we had in recently who was quite fit – on his bike all the time – but the health check revealed he had dangerously high cholesterol levels. When he looked into his family history, he saw that high cholesterol was a hereditary trait that he hadn’t known about. This was something he was then able to address.

Q: What sorts of things are you doing to promote the service? 

A: We have a big Check4Life banner and notice board in the waiting room with leaflets that patients can take away. These tend to catch peoples’ eye. The notice board clearly says who’s eligible so people can make appointments while they’re waiting if they’re interested. We also include stuff for kids – things like the Change4Life activity wheel – as we’ve found that if the kids start getting into it, it can help mum and dad to keep moving. Word of mouth within families is also a really powerful way to promote the service. We have a lot of people saying ‘‘This is brilliant, I need to my husband to have one’. A lot of wives actually book their husbands in whilst they’re here and make them come down! 

Top tips from Bewick Crescent 

1. Have a member of staff take the lead on the service 
2. If people in the surgery are interested and eligible in having a check, book them in there and then 
3. Use patient-friendly software and share the screen with the patient 
4. Adapt to patients’ needs and put on evening clinics if necessary
5. Advertise the service and look to involve kids in any lifestyle change programmes 

Thanks Tracy. Wishing you all a happy and healthy Christmas and New Year!