NHS Health Checks Study
What is the aim of the study and why is it important?
In England the NHS Health Check started in 2009 and is the first programme internationally aiming to improve cardiovascular disease (CVD) risk factors in an entire national adult population through behaviour change and treatment informed by CVD risk stratification. Those eligible are aged 40-74 years without diabetes or cardiovascular disease. The rolling five year programme invites one-fifth of the eligible population each year, aiming for 3 million NHS Health Check attendees annually at a cost of £165 million. The Department of Health report that 5.3 million NHS Health Checks were undertaken in the four years 2011-2015. Implementation has been variable nationally but improved in recent years.
The programme is mainly based in general practices using trained staff including practice nurses or non-clinical Health Care Assistants, though pharmacies are used in a few areas. The NHS Check typically takes about 20-30 minutes and involves measuring blood pressure, weight, cholesterol and checking things like smoking and family history of heart disease. In 2013 the programme transferred to Local Authorities who usually use Clinical Commissioning Groups and GP practices to undertake the Checks. This is the first national study of the NHS Check programme.
How is the research being done?
The study used the QResearch database to identify people who attended and did not attend NHS Checks in the first four years 2009-13 of the programme. It described their characteristics – age, sex, ethnic group and deprivation to see if attendance was equitable and that older people and ethnic minority groups were being seen as often as younger or white groups. We also assessed the cardiovascular risk using (ie. the chance they might have a heart attack or stroke in the next ten years) and whether people who had a high risk of a heart attack or stroke got the right treatment and advice.
In 2017, we received funding from the Department of Health to extend the evaluation for 2013-17.
Queen Mary's University London
Location of research
Date on which research approved
Project reference ID
Generic ethics approval reference
Are all data accessed are in anonymised form?
Brief summary of the dataset to be released (including any sensitive data)
GP data for cardiovascular disease and associated risk factors; information on NHS health checks and relevant medication prescribed
What were the main findings?
Of 1.68 million people eligible for an NHS Health Check, 214 295 attended in the period 2009–12. Attendance quadrupled as the programme progressed; 5.8% in 2010 to 30.1% in 2012. Attendance was relatively higher among older people, of whom 19.6% of those eligible at age 60–74 years attended and 9.0% at age 40–59 years. Attendance by population groups at higher cardiovascular disease (CVD) risk, such as the more socially disadvantaged 14.9%, was higher than that of the more affluent 12.3%. Among attendees 7844 new cases of hypertension (38/1000 Checks), 1934 new cases of type 2 diabetes (9/1000 Checks) and 807 new cases of chronic kidney disease (4/1000 Checks) were identified. Of the 27 624 people found to be at high CVD risk (20% or more 10-year risk) when attending an NHS Health Check, 19.3% (5325) were newly prescribed statins and 8.8% (2438) were newly prescribed antihypertensive therapy.
Implications and Impact
NHS Health Check coverage was lower than expected but showed year-on-year improvement. Newly identified comorbidities were an important feature of the NHS Health Checks. Statin treatment at national scale for 1 in 5 attendees at highest CVD risk is likely to have contributed to important reductions in their CVD events.
Funded by the National Institute for Health Research School for Primary Care Research Funding NIHR 009/0052.
John Robson, Isabel Dostal, Vichithranie Madurasinghe, Sally Hull, Kambiz Boomla, Chris Griffiths, Sandra Eldridge: Queen Mary University of London Julia Hippisley-Cox and Carol Coupland: University of Nottingham Aziz Sheikh: University of Edinburgh
Date on which research was approved
The NHS Health Check in England: an evaluation of the first 4 years
Authors: Robson J, Dostal I, Sheikh A, Eldridge S, Madurasinghe V, Griffiths C, Coupland C, Hippisley-Cox J.
Ref: BMJ Open 2016;6(1).