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

Objectives: To describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England.

Design: Observational study.

Setting: National primary care data extracted directly by NHS Digital from 90% of general practices (GP) in England.

Participants: Individuals aged 40-74 years, invited to or completing a NHSHC between 2012 and 2017, defined using primary care Read codes.

Intervention: The 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.

Results: During 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.

Conclusion: This 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.

Keywords: preventive medicine; public health; vascular medicine.

Figure 1

Study extract and study population flowchart. The study population inclusion dates (1 April 2012 to 31 March 2017) reflect a snapshot of the 5-year rolling programme from April 2012, when all trusts commissioning primary care in England had implemented the programme. *NHSHC activity refers to any interaction that a patient may have had with the NHSHC programme. This includes if a patient was invited to, commenced, completed, declined, did not attend, or was inappropriate for, the NHSHC. More details are provided in online supplemental table 1. GP, general practices; NHSHC, National Health Service Health Check.

Figure 2

Variation in NHSHC uptake across (A) England and (B) London. Uptake rates shown as % of people taking up an offer of a check, between 2012/3 and 2016/17, by upper tier local authority of the individuals’ usual residence. NHSHC, National Health Service Health Check.

Figure 3

Completion of risk factor measurements for attendees and non-attendees (2012/13–2016/17). Proportion of available and missing data for each risk factor related measurements are shown here. Note these are available measurements within the time frame of the data extract (see Supplemental Methods). Family history not shown as coded only as yes with unknown negative/missing data. See also online supplemental table 12 for the completeness values. AUDIT-C, Alcohol Use Disorders Identification Test-Consumption; BP, blood pressure; CVD, cardiovascular disease; HbA1C, haemoglobin A1c; HDL, high-density lipoproteins; GPPAQ, General Practice Physical Activity Questionnaire.

Figure 4

Proportion of attendees and non-attendees with common CVD risk factors. Definitions as per online supplemental table 6) and include: high cholesterol=total cholesterol >5 mmol/L or cholesterol ratio >4; high blood pressure=systolic ≥140 or diastolic pressure ≥90 mm Hg; obesity=body mass index≥30 kg/m²; alcohol>low risk=Alcohol Use Disorders Identification Test-Consumption (AUDIT C) score ≥8; low physical activity=General Practice Physical Activity Questionnaire (GPPAQ) moderate inactive or inactive; possible diabetes= haemoglobin A1C (HbA1C) ≥48 mmol/mol or Fasting Blood Glucose (FBG) >7 mmol/L; current smoker=current smoking; high CVD risk score=10-year CVD risk score ≥10%. *Family history is predominantly only recorded if present so accurate information on its absence is unavailable. See also online supplemental table 6 for more detailed information. CVD, cardiovascular disease.