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Review
. 2022 Nov 10;12(11):e064237.
doi: 10.1136/bmjopen-2022-064237.

Understanding what happens to attendees after an NHS Health Check: a realist review

Claire Duddy  1 , Erica Gadsby  2 , Vivienne Hibberd  3 , Janet Krska  4 , Geoff Wong  5
Affiliations
Review

Understanding what happens to attendees after an NHS Health Check: a realist review

Claire Duddy et al. BMJ Open. .

Abstract

Objectives: The NHS Health Check offers adults aged 40-74 an assessment of their risk of developing cardiovascular disease. Attendees should be offered appropriate clinical or behavioural interventions to help them to manage or reduce these risks. This project focused on understanding variation in the advice and support offered to Health Check attendees.

Design: We conducted a realist review, assembling a diverse body of literature via database searches (MEDLINE, Embase, CINAHL, HMIC, Web of Science) and other search methods, and synthesised data extracted from documents using a realist logic of analysis. Our aim was to develop an understanding of contexts affecting delivery of the NHS Health Check and the underlying mechanisms producing outcomes related to the offer for attendees post-Check.

Results: Our findings demonstrate differences in how NHS Health Check commissioners, providers and attendees understand the primary purpose of the programme. A focus on screening for disease can produce an emphasis on high-volume delivery in primary care. When delivery models are organised around behavioural approaches to risk reduction, more emphasis is placed on advice, and referrals to 'lifestyle services'. However, constrained funding and competing priorities for providers limit what can be delivered within the programme's remit. Attendees' experiences and responses to the programme are affected by how the programme is delivered, and by the difficulty of incorporating its outputs into their lives.

Conclusions: The remit of the NHS Health Check should be reviewed with consideration of what can be effectively delivered within existing resources. Variation in delivery may be appropriate to meet local needs, but differences in how the programme's primary purpose is understood contribute to a 'postcode lottery' in post-Check advice and support. Our findings underline existing concerns that the programme may generate inequitable outcomes and raise questions about whether it can deliver positive outcomes for the majority of attendees.

Trial registration number: PROSPERO CRD42020163822.

Keywords: cardiology; health policy; preventive medicine; public health; risk management.

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Conflict of interest statement

Competing interests: CD and GW are both members of the Royal College of General Practitioners (UK) Overdiagnosis and Overtreatment Group. GW is an NHS General Practitioner and deputy chair of the National Institute for Health Research Health Technology Assessment Prioritisation Committee: Integrated Community Health and Social Care Panel (A) and member of the Methods Group (A).

Figures

Figure 1
Figure 1
Summary of searching and selection processes.
Figure 2
Figure 2
Final programme theory.
See this image and copyright information in PMC

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References

    1. NHS . NHS Health Check, 2020. Available: https://www.nhs.uk/conditions/nhs-health-check/ [Accessed 22/09/2022].
    1. Public Health England . NHS Health Check best practice guidance for commissioners and providers; 2020. https://www.healthcheck.nhs.uk/commissioners-and-providers/national-guid... [Accessed 22/09/2022].
    1. HM Government . Levelling up. Levelling up the United Kingdom. Her Majesty’s Stationery Office; 2022. https://www.gov.uk/government/publications/levelling-up-the-united-kingdom [Accessed 22/09/2022].
    1. The local authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) regulations. Part 2 public health functions: conduct of health checks, 2013. Available: https://www.legislation.gov.uk/uksi/2013/351/made [Accessed 22/09/2022].
    1. The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013. Part 2: Public Health Functions: Health check assessment., 2013. Available: https://www.legislation.gov.uk/uksi/2013/351/regulation/4/made/data.pdf [Accessed 21/09/2022].

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