Cheshire and Merseyside pilots support increased uptake of NHS Health Checks in target groups
By working innovatively, we have seen significant increases in the uptake of preventative health checks amongst priority groups who are at highest risk of dying from heart disease (CVD), such as those living in areas with high levels of deprivation, certain minoritised ethnic groups and patients with severe mental illness (SMI).
The increase in uptake is thanks to NHS England’s Prevention Programme and Core20PLUS5 funding. This enabled a series of local pilots, which explored innovative solutions to increase the uptake of NHS Health Checks and Annual Physical Health Checks for patients with severe mental illness, who have some of the highest health needs.
Pilots were established in Cheshire West and Chester, Halton, Wirral, Liverpool, Sefton and St Helens and worked directly with patients from local target groups to co-design approaches to increase uptake of preventative health checks. Sites worked with eligible patients who live in some of our least affluent communities, minoritised ethnic groups, people who misuse alcohol and patients with SMI.
Local insights from communities, patients and GP practices highlighted barriers to uptake in target groups. Common themes included competing priorities for professionals and patients, venues and travel costs, language barriers, lack of understanding about the checks and limited appointment times and booking systems.
This informed locally developed solutions within traditional and outreach settings that were wide ranging:
- Partnership working with voluntary, community and faith sector (VCFS) organisations, community venues, leisure providers, workplaces and worklessness schemes, and asylum seeker/refugee venues.
- Widened availability of evening and weekend appointments and easier booking through an online booking system.
- Point of care testing (POCT) equipment supported outreach approaches, such as CardioChek, AC1Now, Wellpoint blood pressure kiosks, and mobile ECG machines for SMI checks.
- Weighted payments incentivised NHS health check delivery in deprived areas.
- Links to weight management services strengthened impact.
- Training empowered voluntary partners in carrying out NHS health checks and practices to carry out SMI checks.
- Resources were developed like personalised workbooks, empowering SMI patients about their care and an NHS health check training manual supporting VCFS partners.
- Recruited nursing and link staff supported practices with SMI check invites, appointments, delivery, data capture and referrals.
- Bespoke data dashboards developed to prioritise invites by deprivation and/or ethnicity.
- Adapted invites to reduce language barriers and increase understanding.
- Data quality measures included updating eligible patient lists and templates to standardise data capture and coding.
- Cross-sector IT solutions were put in place to support better data collection from outreach activities and in the transfer to GP systems such as EMIS.
How does this improve population health?
Health check uptake increased in target groups.
NHS health check (NHSHC) uptake in target patient groups increased in all mobilised pilot sites, with increases over the pilot period (Q1 21/22 to Q4 22/23) ranging between 98% and 614%, for respective target groups and sites.
While this lagged behind increases in overall NHS Health Check uptake for the same time period, pilots were relatively small-scale, proof of concepts and valuable learning has been captured with huge potential to be scaled-up into business as usual.
SMI Annual Health Check delivery and quality increased in participating GP practices, with half (3 out of 6) of participating practices in Picton, Liverpool, and over half (17 out of 30) of participating practices in St Helens, reaching 50% delivery by March 2023.
A series of recommendations for the future include:
- Support health check providers to embed targeted approaches within universal delivery models.
- Support collaboration with VCFS, leisure, workplace/worklessness and other community partners.
- Embed digital solutions to improve targeting, data capture and cross-sector data flow.
- Increase availability of Point of Care Testing for outreach models.
- Provide translated resources for NHS Health Checks and also for follow on health and wellbeing behaviour change support.