Engaging with GPs
to help deliver the
NHS Health Checks
Dr Matt Kearney
GP Castlefields, Runcorn
National Clinical Advisor Public Health England and NHS England
Why do we need GP engagement?
1. To ensure quality in NHS Health Checks delivered by GP practices and to
ensure quality in primary care follow up for NHS Health Checks done by
other providers
2. The NHS Health Check is more than a single intervention. It is a risk
assessment and management pathway, most of which lies in primary care
3. The NHS Health check will fail to deliver on its health and economic
promise if we do not get GP engagement right
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NHS Health Check Pathway
Diagnosis
Risk assessment
Risk Management
Age
smoking
Gender
Ethnicity
Family history
•
40 -74
NHS HEALTH
CHECK
Alcohol
physical
activity
Alcohol use
Physical activity
Body Mass Index (BMI)
A pathway - not a
standalone activity
Cholesterol test
BP Measure
Diabetes filter
• BMI
• BP Measure
•
Dementia
awareness and
signposting
65 -74
• Multi-component
intervention
Good quality
primary care a core
component
Lifestyle
interventions
Smoking status
Weight
High BP
Risk
Assessment
High risk
of DM
? Diabetes
If at risk
HbA1c or Fasting
Glucose
RECALL
High CVD
Risk
? Hypertension
? CKD
Impaired
Glucose
DM
Consider
statin
Treat BP
CKD
Management
Diabetes
register
High Risk
register
Hypertension
register
CKD
register
Important to acknowledge that GPs
have understandable concerns
• Questions over the evidence base
• Influx of the worried well increasing health inequalities
• “We treat the sick…we don’t do prevention”
• Concerns over AQP competence and validity of measurements
• Safety of data transfer and work load of data entry to clinical records
• Challenge of professional competition from AQP
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Essential to have a local strategy
for GP engagement
1. Acknowledge that engagement is challenging and will take time
2. Nurture and support local champions – GPs, nurses, practice managers
3. Build local networks of interested primary care providers – they may be
small to begin with!
4. Make the broader case: align NHS Health Check objectives with
GP/CCG/LA priorities for CVD
5. Encourage the HWB to challenge CCG/practice performance on the NHS
Health Check
6. Try to get LMC/CCG co-ownership of quality assurance
–
Competence, standards, procedures
7. Benchmark, feedback and advertise quality and achievement
8. Celebrate success
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NHSE & PHE are working nationally
to build primary care engagement
1. Broadening the narrative from “NHS Health Check good or bad” to “How do we
improve prevention, detection and management of CVD and CVD risk in primary
care”, with the NHS Health Check being part of the solution
2. Working with RCGP to establish CVD prevention, early diagnosis and treatment
as a College priority with Clinical Champion
3. Established a national Primary Care CVD Leadership Forum of GPs and nurses
4. Working with NCVIN have produced CDV Intelligence Pack
5. With SCNs running a series of regional CVD workshops for CCGs
6. Bruce Keogh has written to CCGs stressing the importance of the NHS Health
Check as an NHS priority
7. Exploratory work to support development of local NHS Health Check
dashboards or audit tools
8. Range of published papers and conference presentations
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GP Contract as driver
GPs are contracted to record clinical information relating to their patients
that is received from other health professionals:
– 16.1.2. The Contractor shall keep adequate records of its attendance
on and treatment of its patients and shall do so (a)on forms supplied
to it for the purpose by the Board; or (b)with the written consent of the
Board, by way of computerised records, or in a combination of those
two ways.
– 16.1.3. The Contractor shall include in the records referred to in
clause 16.1.2 clinical reports sent in accordance with clause 7.10 or
from any other health care professional who has provided clinical
services to a person on its list of patients.
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Care Quality Commission as driver CQC inspection prompts
“In this practice:
1. Do people have access to appropriate health assessments and checks?
(This includes health checks for new patients and NHS health checks for
people aged 40–74.)
2. Is there appropriate follow-up on the outcome of health assessments and
checks where abnormalities or risk factors are identified? (For NHS health
checks this includes where the GP practice is not carrying out the health
check.)”
Practices are likely to be highly motivated to ensure that their services meet the
CQC standards
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What does the evidence tell us?
Slide deck reviews the rationale for and the
evidence relating to NHS Health Check
http://www.healthcheck.nhs.uk/document.php?o=824
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In the absence of perfect evidence, the NHS
Health Check offers a rational, systematic
approach to prevention and early detection
1. There is a wealth of evidence in relation to the interventions
delivered by the NHS Health Check
2. There is a dearth of evidence in relation to the NHS Health Check
as a delivery method
3. Lack of evidence of effectiveness should not be confused with
evidence of lack of effectiveness
4. Do nothing is not an evidence based response - NHS Health Check
offers a systematic approach to case finding and delivery of
evidence based interventions
5. Our focus should be on optimising the reach and quality of NHS
Health Check while generating robust evidence
6. Ongoing risk management in primary care is a core element of the
NHS Health Check pathway and essential for improved outcomes in
CVD
NHS Health Check Pathway
Diagnosis
Risk assessment
Risk Management
Age
smoking
Gender
Ethnicity
Family history
•
•
•
A pathway - not a
standalone activity
Multi-component
intervention
Good quality
primary care a
core component
40 -74
Alcohol
physical
activity
Alcohol use
Physical activity
Body Mass Index (BMI)
Cholesterol test
BP Measure
Diabetes filter
• BMI
• BP Measure
65 -74
NHS HEALTH
CHECK
Lifestyle
interventions
Smoking status
Dementia
awareness and
signposting
If at
risk
HbA1c or Fasting
Glucose
High BP
RECALL
Weight
Risk
Assessment
High risk
of DM
?
Diabetes
High CVD
Risk
Impaired
Glucose
D
M
Consider
statin
? Hypertension
Treat BP
? CKD
CKD
Manageme
nt
Diabetes
register
High Risk
register
Hypertension
register
CKD
register
[email protected]
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