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.

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)