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!

NHS Health Check learning resources digitally published online

In a bid to increase access to Health Diagnostics’ library of published materials, a large amount of content has been made digitally available online. The contents of this library can be viewed as online magazines through a range of devices including computers, tablets and phones. Having been closely engaged with reporting on the national programme since its inception, the hope is that these materials will enhance the rich array of free NHS Health Check learning resources available online. So what’s included in Health Diagnostics’ digital library?

NHS Health Check News

The first edition of NHS Health Check News is featured in the library, as will be a forthcoming issue. The newspaper's first issue - released at Public Health England’s February 2014 conference - includes a range of articles that focus on issues such as the latest research and developments in provider competencies. The centerfold features a case study on County Durham’s Check4Life programme and documents how the ‘end-to-end’ solution is being implemented in the North East. Click the title link to view the newspaper.

Example Training Materials

This section features the Motivational Interviewing workbook that’s supplied to providers on training days. The workbook is intended to give guidance and advice on how to encourage constructive lifestyle conversations that promote positive lifestyle change. Whilst Health Diagnostics offer a number of training materials and guides to providers, this workbook is the only example that’s made freely available online for public use. Get in touch to find out more about Health Diagnostics’ range of training resources. Click the title link to view the workbook

NHS Health Check Leadership Forum

This report contains the summary and findings from the first NHS Health Check Leadership Forum. The forum took place during the 2013 Commissioning Show where public health professionals came together to share learning and experience of NHS Health Check programme delivery. An expert panel presented the findings from a range of local projects and public health researchers reported on the early indications from the national evaluation. Click the title link to view the report.

Picture of Health Reports

During 2012 – amid unprecedented changes being made to the commissioning and delivery of NHS services – Health Diagnostics sponsored the production of the Picture of Health reports. This series of three reports and a case study offered clear and comprehensive information on the transition of public health from PCT to local authority control. Produced by Andy Cowper, editor of Health Policy Insight and Achieving Commissioning Excellence, the documents were made up of interviews with experts from around England. They continue to offer unique insights into the commissioning and delivery of NHS Health Checks through local authority. A case study on the North East of England’s service model is included. Click the title link to view the reports and case study.

Health+Care show, 2014: Showcasing the latest tools for NHS Health Check delivery at London's ExCeL centre

With the 2014 Health+Care show getting under way in London today, the country’s public health authorities are gathering to discuss the state of the nation’s health and the innovative ways in which the NHS is evolving to manage the £2 billion funding gap it’s faced with.

Health Diagnostics are present and amongst the show’s official top 20 ‘must see’ exhibitors. In addition to showcasing Health Options® – one of the leading risk assessment software programmes for NHS Health Checks – we’ll be taking delegates through some of the latest tools for delivering and managing the national programme.

Amongst the tools displayed on stand M40 will be the new 'call and recall' system that’s allowing public health leads to find, invite and deliver health checks to their target cohorts. Our secure data transfer module for returning patient data to any GP system will also be on show alongside a series of new health check training videos that we've produced with the help of our NHS and Local Authority partners.

With all the elements in place, Health Diagnostics’ system represents the complete solution for delivering health checks:

Identify and invite with 'call and recall'

As the first link in the chain of delivery, the call and recall module allows for targeted NHS Health Check invites to be sent to individuals. By sampling the population, the software can determine precisely those that are eligible and at risk, as well as generate tailored invites for the identified cohort.

Deliver a health check with Health Options® software

We’ll be taking delegates through the CVD risk assessment software that’s used by Local Authorities up and down the country. Having been designed with ease-of-use in mind, the software structures and supports the delivery of motivational consultations. With a range of additional functions for data management, the IT solution is both at the core of the data transfer process and the front-line of health check delivery.

Receive detailed public health analysis

We’ll be showing examples of our reports that provide commissioners with detailed analysis on local health trends and provider performance. Generated by analysing data that’s been securely sent to us over an encrypted network, these reports are there to help those in charge make fully informed decisions when shaping local public health policy.

Transfer data to any GP system

Returning data to any GP clinical system securely via the N3 network has, for a long time, been the holy grail of a complete ‘end-to-end’ delivery model. Health Diagnostics have responded to this need and will be taking delegates through the tool we’ve developed for transferring data back from service providers, to individual patient records.

Use the latest training resources

We've worked closely with our Local Authority and NHS partners to produce training videos demonstrating full consultations that adhere to best practice. In addition, a promotional video that can be used by providers in venues and online has been made freely available. These can be viewed here.

So if you're at the show today or tomorrow and are interested in how NHS Health Checks are being managed centrally and delivered locally, we'd love to have a chat. You'll find us at stand M40!

Share, listen, act: Update on the NHS Health Checks in East London ~ Part 2

Part 2:

Following on from Part 1 of the 'Share, listen act' series where we had the initial reaction to last month's NHS Health Check conference, this post will focus on the achievements of the NHS Health Checks in ethnically-diverse East London.

Dr John Robson, a GP working in East London who co-authored the QRisk algorithm with Julia Hippisley-Cox, was responsible for delivering the latest findings in relation to coverage and uptake of NHS Health Checks in the area. 

For the purposes of the project, three Local Authorities comprised ‘East London'. These are listed below, as well as ranked out of the UK's 150 Local Authorities in terms of overall premature mortality:

- Newham (ranked #110)
- City & Hackney (ranked #132)
- Tower Hamlets (ranked #139)

Despite all featuring in the bottom third of UK LAs for premature deaths, the percentage uptake of the scheme in 2011/12 was 74%. This indicates that 21,194 people from those 3 areas had an NHS Health Check; a figure above the current national average of 50% and well above the upper target of 66% as set by Professor Kevin Fenton. Newham even managed 81% uptake.

In regards to the equity of the uptake of the health checks by age, ethnic group and deprivation, Dr Robson echoed much of what Health Diagnostics have seen in collating and analysing NHS Health Check data:

Main findings

1. Older people (>60 years) were more likely to attend a health check (perhaps because they are more likely to be high risk, are stratified as such and are therefore offered a health check).

2. There was no particular difference of uptake based upon quintile, although this is misleading in the three East London areas that the research covered, as the areas were almost exclusively in the 4th and 5th quintile. In 2011/12, 11% of health check attendees had a Townsend Quintile score of 4, whilst 88% had a Townsend Quintile score of 5.

3. There was a significant uptake of the health checks amongst South Asian and black African/Caribbean populations. In 2011/12, 41% of the Health Check attendees were from a South Asian or black African/Caribbean ethnicity band, compared to 28% of non-attendees. 

Overall 

Of those attending an NHS Health Check, 31% had a CVD risk score of at least 10%. In real terms this equated to 15,876 people identified as medium/high CVD risk. These figures would suggest a significant number of people could benefit enormously from identifying risk increasing behaviours earlier in life. For the Local Authorities concerned, responding with targeted educational and health awareness campaigns may prove crucial.

Following on from the risk identification of the health check, of those classified as at high CVD risk overall (200,000 people out of 2 million attendees), around a third (60,000) were prescribed a statin. This would result in an overall decline of instances of CVD by 25%, accounting for a reduction of CVD events by 1500 cases in 5 years. 

The findings from this study point to the significant, positive effect that the NHS Health Check programme can have in lowering CVD risk. In the face of such encouraging evidence, it is understandable that the debate on the utility of the health check programme has subsided in recent months.

Findings conveyed by Health Diagnostics’ Systems and Data Manager, Michael Storry.

Share, listen, act: Reaction to Public Health England’s NHS Health Check conference, 2014 ~ Part 1

Part 1:

This year’s NHS Health Check conference was the largest to date, with hundreds of delegates from across England and Wales coming together to share best practice. 

Taking place at London’s Kennington Oval cricket ground (right), the invited audience was comprised of individuals currently designing the future of this country’s preventive health and lifestyle services.

Amongst the range of speakers asked to present their expertise was Health Diagnostics’ MD, Julie Evason, who after 30 years in the health check business, was ‘‘very pleased to be able share the accumulated learning!’’

Commercial providers role in the NHS Health Check programme: featuring Julie Evason as a panel member

Julie took to the panel after lunch alongside Public Health England’s (PHE) Director of Health and Wellbeing, Professor Kevin Fenton, and a number of other commercial providers from the likes of Boots and Asda. 

Taking the opportunity to discuss some of the pressing issues facing those coordinating health check programmes, Julie outlined Health Diagnostics’ approach to developing answers to the most commonly-voiced problems. Emphasising a particular interest in IT, she stated that Health Diagnostics ‘‘strive to create simple solutions to what can often appear to be overly complex scenarios.’’

The importance of partnering with organisations in order to be able to generate swift resolutions to local authority (LA) issues was a key feature of the speech. As Julie stressed, ‘‘Health Checks are here now. The solutions are required now.’’ Giving an example of precisely what's required, Julie informed the audience:

‘‘Health Diagnostics partner with a number of like-minded specialist companies who can see the strength in working together and they have helped fast track the development of our range of IT solutions which now include modules for cohort identification (that all elusive call and recall) and the ability to return data to any GP clinical systems well within the expected 48 hours.’’ 

Moving from topics such as the available range of delivery mechanisms, to the financial advantages to using point of care equipment, this address covered significant ground in speaking directly to the concerns of the commissioners and programme leads present.

Reflecting on the discussion, Julie remarked that it ‘‘really feels like momentum is building for the NHS Health Checks and I’m very pleased that Health Diagnostics’ offer fits the bill so well. It was a pleasure to be invited onto the panel. It’s really refreshing to see that PHE recognise us as a quality provider in this arena.’’

Conference feedback from Health Diagnostics' delegates

Jen Sutherland, Systems Support and Account Manager

‘‘There was a real buzz about the place - a very pro-active and can-do feel. LAs that are currently using a spreadsheet to record the health check results were very impressed with Health Options® software for recording the information, receiving reports and also how patient focused it is. It really feels like we have an answer to a lot of the problems they’ve experienced.

A number of people commented on their existing software companies taking a long time to implement new changes, (e.g. dementia awareness and pulse palpation requirements). They were pleasantly surprised to learn that we listen carefully to customer feedback and respond quickly to new changes.’’

Julie Evason, Managing Director

‘‘The quality of the delegates was excellent. We had more focused discussions in that one event than at any other show going over two or three days. The fact that this year's event involved as many people as it did really stimulated discussion across all areas with lots of practical advice and tips being shared.

I was surprised by the misconception that much of the IT capability isn’t available when it is, however it’s great to know that we’re fulfilling the evolving requirements of the programme.

What seemed slightly strange was that so many LAs are spending months researching the requirements to put a tender in place. It would make a lot of sense if PHE could provide a template that could be tweaked locally.’’

Selina Donnelly, Training and Account Manager

''It was refreshing that everyone I spoke to was looking for a way to really drive the quality of the health check service.

Hearing that PHE are in favour of looking to alternative providers to GPs was very exciting. It’s great to have been closely involved in the research that’s helping to inform the debate.''

Keep an eye out for parts 2 and 3 of the Share, listen, act blog series, which will feature:

• Part 2: A report on the National evaluation update by Health Diagnostics’ Systems and Data Manager, Michael Storry.
• Part 3: A report on the The new guidelines for NHS Health Check information governance and data flows by Pete Roberts, Senior Solution Developer & Information Security Manager
 at Health Diagnostics.

New NHS Health Check training videos: service users share their experiences

March 2014 is set to be a significant month for the NHS Health Check campaign, with the release of the JBS 3 cardiovascular prevention guidelines and a series of comprehensive new training videos for providers and service users.

Featuring full-length consultations, the training videos will offer providers an invaluable insight into what best practice looks like in action. The individuals carrying out the checks are all experienced Check4Life providers who’ve been responsible for delivering a consistently high volume of checks for a number of years.

In addition, the materials – which will be freely available on YouTube – will serve as an information source for any member of the general public interested in finding out what having a check is all about.

With the health checks being real as opposed to staged, the videos really capture the impact that effective, non-judgemental consultations can have. Keith and Bruce, two men that received consultations as a part of the project had only positive things to say about their experiences:

Bruce, 40 years old, from Durham, was given a health check by Dawn from John Low’s Medical Centre in Consett, County Durham

Bruce before his first health check five years ago

‘‘It was really interesting. I actually came for a health check five years ago when the scheme was first being introduced and functioned as a bit of a guinea pig for the pharmacists to train on!

The results I got today are phenomenal in comparison to last time. When I came first time around, I was leading a completely different lifestyle to what I am now and it was a real eye-opener when I saw my results. I was drinking a huge amount more than I am now and I was a heavy smoker as well. As a result of the health check, I put a stop to both these habits and began eating a lot healthier.

In short, the health check had an extremely positive impact, so much so that I’ve since been able to complete a number of Ironman challenges and am planning to race seven marathons in seven days across the Sahara this year! I couldn’t even run to the pub five years ago!

Even last time, I remember Dawn being really professional and very non-judgemental in her style. Today was no different, I felt very relaxed and comfortable.

I’d recommend it 100% to others. Five years ago, I thought that I was pretty healthy because my job’s always been fairly active. It turned out that I really wasn’t doing enough though. In fact, because of my lifestyle I was building up real problems for myself. My results today have confirmed that I’ve been able to turn all this around.’’

Bruce in August, 2013

Keith, 55 years old, from Durham, was given a health check by Nicola of County Durham’s Check4Life team:

‘‘From the greeting onwards, I thought the whole thing was really professional. Nicola explained everything really well for me and I understood precisely what was going to happen.

What was quite surprising was how I wasn’t being judged in any way, shape or form. I wasn’t told I was fat, drinking too much or not exercising enough, Nicola just gave me the information and let me make my own judgement about it.

The health check has certainly given me the evidence and incentive to make more changes to my lifestyle.

I’d definitely recommend it to anybody; there’s nothing to be frightened of. Even the finger-stick sample is nothing really. The thing is, it lets us find out how we are because we don’t know what we’re like inside until somebody helps you to see what you are.’’

The training videos will be officially released in March. Keep an eye on this blog for details.

Rounding-up 2013's public health debates and looking forward to the coming year

2013 has proved to be a significant year for English primary care. With the transition of public health from PCT to local authority, April saw the introduction of a whole new system of structures for healthcare commissioning and provision. Whilst it’s still too soon to say whether this move has delivered the desired effect of making local health services more relevant for the communities they’re provided for, the indications from the second half of the year suggest that there’s an increased sense of stability in the sector by comparison to this time last year. For many however, this will hardly come as a surprise given how many NHS departments, let alone individual positions, had uncertain futures twelve months ago.

Plain packaging

One of the biggest public health stories from 2013 was the debate around the plain packaging of tobacco products. The issue became increasingly mired in controversy after it emerged that Lynton Crosby – a campaign consultant at the heart of Downing Street – was also actively representing the interests of the tobacco industry. Although out of the limelight for the time being, this issue along with other public health measures such minimum unit pricing are unlikely to be out of focus for long. Their importance in combating what Dr Zafar Iqbal and others have described as the ‘social and market forces which help to perpetuate health inequalities’ will undoubtedly mean their re-emergence in 2014. Our coverage and perspective on the story can be revisited here.

CVD prevention

The summer also saw Public Health England placing an increased emphasis on promoting cardiovascular disease prevention. However as PHE and the Health Secretary served up the evidence on the predicted benefits of England’s flagship CVD prevention programme – the NHS Health Check – others were voicing their doubts as to the projected net gain. As it has emerged, many of the charges levelled against the programme by critics have been based on misrepresentations of the English model of CVD prevention. Again, our in-depth critique which draws out the specifics of the argument can be read here.

Going forward: the macro view

Fortunately, for those on the ground and working hard in communities to provide the health checks and increase awareness on the effects of poor lifestyle behaviours, the news looks positive. Recognising that ‘doing nothing’ in regard to national health inequalities ‘is not an option’, NHS England’s chief financial officer this week announced an increase in funding for NHS commissioners from £96bn to £100bn over the next two years. As well as the increased budget, a new funding formula for local health commissioners ‘that more accurately reflects population changes and includes a specific deprivation measure’ is said to be being introduced. With the NHS Health Check at the very centre of CVD prevention policy, these announcements should provide the means to continue increasing the efficiency and effectiveness of a programme that is already estimated to ‘prevent 1,600 heart attacks and strokes, at least 650 premature deaths, and over 4,000 new cases of diabetes each year’.

Developments at Health Diagnostics

With this comprising the macro-outlook, a big question going forward for us at Health Diagnostics is: how can we best support the drive to alleviate health inequalities and the growing social and economic burden of cardiovascular disease in our own capacity? We’ll certainly be working hard to continue providing a first-class service to all our NHS partners, however in addition a handful of the new developments will include:

• Working closely with reputable academic institutions to help establish empirical outcome data on the efficacy of the NHS Health Check. The potential benefit of using Health Options® software in delivering the health checks will be investigated in particular.

• A new software release is planned for January 2014. This latest version will include some exciting new developments including the integration of the Diabetes UK questionnaire.

• To coincide with this software release, Health Diagnostics are launching the new range of client report fact sheets. With a keen emphasis on design and clarity, the new reports are intended to facilitate the communication of essential health information. With tens of thousands set to be distributed, the team at Health Diagnostics have been working hard to make the reports as coherent, concise, and informative as possible.

• We’ll again be attending the Commissioning Show in June, with details set to be announced closer to the time. To view the findings of the events run in conjunction with the 2013 show, click here.

Until 2014 then, wishing you a happy and healthy Christmas and new year!

Evidence and outcomes: research into pharmacy delivered NHS Health Checks

Questions over measurable outcomes have been a consistent feature of the NHS Health Check debate since the programme was rolled out in 2009. Given the scope and ambition of the service, as well the vocal opposition to it, articles calling for evidence have become a regular feature in public health journals. In this post, we’ll be drawing attention to some of the empirical studies that are currently informing the debate. Specifically, these studies focus on alternative delivery methods, particularly via pharmacy.

A crucial factor to bear in mind when considering the evidence is that despite the programme being nationally mandated, there is no single mandated way of delivering it. The systems in use across England vary widely in terms of the emphasis they place on design, user-friendliness, and encouraging lifestyle improvement. The studies cited here all use a patient-focussed solution developed by Health Diagnostics. A demo of the software component of the solution may be watched here).

Evaluating Leicester City’s Healthy LifeCheck programme

This evaluation focussed on a service that was delivered by community pharmacists in Leicester City.

In the introduction to the research that was published in the Journal of Public Health in March 2013, the rationale for evaluating the pharmacy-led programme is explained:

‘‘In the past, risk screening programmes have been exclusively undertaken within primary care sites. It has been suggested that such an approach may widen health inequalities by excluding those who do not routinely access organized health care… Subsequently, emphasis has been placed on the importance of incorporating second sector organizations in delivering a vascular risk assessment service’

This work thus assess precisely how important it is to have a ‘many-pronged’ approach when tackling local health inequalities. The study involved a sample of 2,521 individuals, which were recruited from 39 pharmacies. The method and results may be read in full here.

In short, the conclusions to the study spoke resoundingly in favour of pharmacy’s ability to identify and engage with people that may otherwise slip under the radar:

‘‘Cardiovascular risk assessment led by community pharmacists can successfully assess people from large, multi-ethnic UK populations and identify those at high cardiovascular risk or with undiagnosed cardiovascular disease. The service may improve rates of assessments undertaken by individuals who do not access health care through traditional routes.’’

By way of a comment on the particular advantages offered by pharmacy, the study’s authors noted:

‘‘The current study demonstrates the suitability of a pharmacy-led system in including those from a minority ethnic background; perhaps due to the extent to which pharmacies are integrated within local communities and their ability to provide information in a number of languages and formats.’’

Evaluating Sefton PCT’s Cardiovascular screening programme

This second study was carried out in the School of Pharmacy and Biomolecular Sciences at Liverpool John Moores University. It engaged 10 pharmacies delivering the NHS Health Check programme and was published in June 2010.

The report makes the following comment in regard to the collated views on the pharmacy CVD screening service:

‘‘Almost all of the participants had a positive experience of the screening process, with 96 (99.7%) agreeing that they were given enough time for the screening and that pharmacists made them feel at ease. Similar high numbers felt comfortable discussing their lifestyle with the pharmacist. Indeed for many, their expectations of what the screening would cover were exceeded. A further 91 (93.8%) participants agreed that the screening had been done in a suitable place. However, nine (10.8%) had questions that were not discussed during their consultation.’’

Seeing empirical research confirm that NHS Health Checks are being well-delivered by providers outside of GP practices is dispelling the myth that targeted lifestyle interventions can only be carried out by doctors. Given the strain that GP’s are under, as well as the pressing need to raise widespread awareness about the importance and practicalities of leading a healthy lifestyle, looking to the secondary sector should really be something for local authorities across England to consider.

For further information or a localised appraisal of the potential impact of extending the provider network, contact Health Diagnostics at info@healthdiagnostics.co.uk or on 01244 311811. All reports are produced using evidence-based economic modelling.

NHS Health Checks in pharmacy: Hillingdon’s high performer

(Rishi Verma from Ruislip Manor pharmacy takes a patient through an NHS Health Check)

The context

In recent weeks, Public Health England (PHE) declared that 15 million NHS Health Checks will be delivered between now and 2018/19. In an article with Pulse, Prof Kevin Fenton, Director of Health and Wellbeing at PHE, stated the opportunity this represents for pharmacy:

‘‘What we’re also seeing as local authorities take up leadership of the programme is that they’re beginning to identify other key partners in the primary care family who can also be a part of health checks. This may involve community pharmacies, particular voluntary or community sector providers who can also be involved in the risk assessment and management activities associated with the community.’’

However, in order for pharmacy to make a meaningful contribution to the programme, a proactive and engaged mind set is key. A common discussion topic amongst those who commission and manage the delivery of the NHS Health Checks has been ‘what level of value can pharmacy bring to a health check delivery network?’

The answer is that it depends entirely on how committed and enthusiastic the pharmacies are. The variation in performance can be wide, however when done well pharmacy carries the potential to be an incredibly valuable weapon in the public health arsenal.

Making it happen in Hillingdon

Of the 20 pharmacies delivering the health checks across the London borough of Hillingdon last financial year, a standout performer was Ruislip Manor pharmacy. The person responsible for driving the CVD assessments is Rishi Verma, the pre registration student at the pharmacy.

Of all the health checks conducted in the pharmacy last year – of which there were well over a hundred – the overwhelming majority were done when Rishi began working in the pharmacy and took it upon himself to champion the health checks.

‘Every interaction is an opportunity’ Rishi explained; ‘delivering the health checks can be really rewarding and they’re great for building patient rapport... Crucially, if you offer someone good care, they’ll keep coming back to you.’

The impact of Rishi taking responsibility for the checks underlines how important strong leadership is at every stage of health check delivery. Regardless of if you're commissioning the service or delivering the checks, the success of the programme depends hugely on energised individuals taking the reins.

‘It’s about creating an atmosphere of positivity and opportunism’ said Rishi. ‘The pharmacy team all got on board and found potential patients in the client group. This gave us a good cohort to target. Additionally however, if anyone comes into the pharmacy and they’re over the age of 40, I let them know that there’s a brilliant scheme to help them find out their risk of developing cardiovascular disease. What surprises a lot of people is if I tell them that the same test done privately could cost the upwards of £80.’

Rishi openly admits that he’s obsessively driven to do the best he can possibly achieve; so much so that he’s taken it upon himself to go round local businesses handing out leaflets during his lunch hour. One particularly motivating factor was identified as a training day that was run by Health Diagnostics last year. ‘We were really enthused by the PCT meeting where the agenda was set and the staff trained’ explained Rishi.

Going forward, Rishi has big ideas for hosting community events in his locality: ‘I’ve even engaged a local library where I’ve been delivering health checks. The libraries have community targets to meet so I said to them that I’d come in and deliver the assessments for a day; all they’ve needed to do is promote the event.’

Having championed the checks at Ruislip Manor and completed a university project on public health which fit closely with the NHS agenda, Rishi has accumulated some valuable learning. For those providers who’d are looking for advice on how to boost your numbers, Rishi has a series of recommendations:

-  Mention it to anyone and everyone that looks eligible

-  Have yourself a ‘pitch’ at the ready

-  Stick your individual pharmacy stamps on the leaflets so that people register your venue as the place to get checked

-  Word of mouth can work wonders. Tell people to inform their loved ones who may be eligible

-  Pharmacies can use MURs to determine eligible clients

-  Maximise any community events that go on in the area. Ruislip pharmacy, for example, do well off the back of the local fun day that runs twice a year where local businesses open up a stall on the main street

If pharmacy is to ‘stand up and be counted’ in the reformed NHS – as Chemist and Druggist put it in an article published in April – this kind of innovative and ambitious approach will need to be exploited by pharmacists everywhere. And with PHE aiming to do 15 million NHS Health Checks, the opportunity is certainly there for those that want to make a name for themselves and their business.

Sanjay Doegar, the pre registration tutor at Ruislip Manor had this to say: 'Rishi's performance in health checks is outstanding and his drive to bring on new services has been exemplary. Through his actions we have successfully taken on the free condom service a key performance target for both prevention of STI and teenage pregnancy. We are also a high performer in the Chlamydia screening service.'

(Rishi Verma and Sanjay Doegar at Ruislip Manor)

Using Motivational Interviewing during NHS Health Checks

Among the most keenly discussed topics at this month’s NHS Health Check Leadership Forum was the need to make every contact count. The approach aims to ensure that NHS Health Check providers maximise every opportunity to talk to individuals about their health. What’s more, meaningful and motivational consultations are essential if the programme is to achieve the impact it promises.

In reality, the process of encouraging individuals to consider behaviour change is a delicate task. However, having constructive conversations can be greatly assisted by practicing certain Motivational Interviewing (MI) techniques. A central idea of MI is that individuals are far more likely to be convinced by their own arguments than those imposed by others. As such, the method looks to elicit an individual's inner motivation to change. Above all, a non-judgemental attitude that facilitates a conversation that’s relevant to the concerns of the person having the health check is essential.

Achieving these objectives is possible through a combination of techniques outlined by Miller and Rollnick in MI-3. However, given the specific circumstances offered during a health check, brief interventions often need to be – as their name would suggest – brief. As such, delivering a 20 minute counselling session is often not possible. The question for health check providers is then, ‘how can we make a difference in the minutes that are available to us?’

In order to provide guidance on precisely this matter, Health Diagnostics have produced a pack of training and consultation materials. These are provided to anyone trained at a Health Diagnostics training day. (See below for image). The pack includes:

• A booklet that condenses the techniques outlined in MI-3 into a framework for approaching NHS Health Check consultations
• A range of Top Tip cards which may be used by practitioners to offer bite-size practical advice on lifestyle choices
• Access to a video demonstrating some of the MI techniques in action

Due to the time pressures during a NHS Health Check, using visual tools as a support is an invaluable way to encourage behaviour change. With this in mind, Health Diagnostics have built a number of tools into Health Options® in order to aid the user in explaining and eliciting information about lifestyle. Targeted use of these tools is covered in the pack materials, as well as being featured in the forthcoming video of the recent NHS Health Check Leadership Forum which was hosted by Health Diagnostics earlier this month.

During the Leadership Forum, a number of topics were examined by public health experts implementing and delivering health checks. The audience and panel discussed many issues, including how to cleverly target the checks, transferring data electronically to the patient’s record, and innovative ways of boosting uptake. The initial findings from the national evaluation were also presented by Dr Michael Soljak, Clinical Research Fellow at Imperial College London.

As a follow up to the event, the findings will be published on www.healthdiagnostics.co.uk as both as a video and PDF thought piece in early July. More details on the panel can be accessed here.

In addition to the aforementioned resources, there are some useful interactive online learning resources provided by the NHS that can be accessed through the professional learning environment.

(above: the Motivational Interviewing pack)