Increasing uptake: NHS Health Checks

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Read how Haelo, commissioned by Salford City Council from 2013-2016, used improvement science methodologies to increase the uptake of NHS Health Checks in Salford.

 

A mid-life MOT

Levels of deprivation and poor health in Salford are higher compared with the national average. Whilst premature mortality due to heart disease has fallen, rates are again still higher than average. The NHS Health Check acts as a mid-life MOT for those aged 40-74, providing a cardiovascular disease risk assessment and follow up prevention programme.

The NHS Health Check programme offers a fantastic opportunity to tackle avoidable deaths, disability and reduce health inequalities in England.

Salford City Council commissioned Haelo to deliver a Breakthrough Series Collaborative improvement programme in order to increase patient uptake of NHS Health Checks in Salford.

My NHS Health Check

The check itself takes approximately 30 minutes and consists of a small number of questions, simple measurements, plus a blood test to measure a patient’s cholesterol level. The results are then used to calculate the patient’s risk of developing conditions such as heart/kidney disease, diabetes, stroke and dementia.

The check also provides an opportunity for delivery staff to provide an individualised plan for the patient to improve their health and wellbeing.


Working together

In 2014, Haelo began its programme of work with Salford City Council, Salford Clinical Commissioning Group, The University of Salford and other organisations, to deliver a programme which aimed to increase the uptake of the NHS Health Checks in Salford.

Haelo worked with partners and stakeholders to develop a programme of work to meet the set aim, which was represented in a single “Driver Diagram”. The Driver Diagram acted as a road map for improvement activities. In addition, Haelo delivered a suite of measures to monitor the progress of interventions.

Haelo and its partners aimed to increase the uptake of NHS Health Checks in Salford from 38% in 2013, to greater than 60% in 2014/15.

All partners worked collaboratively to determine how this could be achieved through the following methods: informing the population and providers about the health checks, capturing eligible population, conducting the health checks and ensuring support systems were in place to support the delivery of the health checks.


Spreading the word: Initiating change

Using the Breakthrough Series Collaborative model, a series of workshops were held, interspersed with action periods for intervention testing. Participants found these workshops were a useful forum for sharing ideas, talking about breakthroughs and barriers, and celebrating success.

Below are some of the comments from attendees:

“I gained some good ideas to try in my GP practice regarding invites and completing health checks.”

“I will share this information on quality improvement and cascade it to other staff to improve the uptake of health checks.”

“I want to work with Haelo to get patients in for appointments and to meet our target for the year.”

With facilitation from Haelo, participants identified key interventions which could increase the uptake of the health checks in Salford, with the potential of being shared with a wider audience.

NHS Health Checks improvement bundle

  • Media and publicity campaign. In conjunction with our partners we developed posters to encourage the eligible public to have a health check. The text and pictures included local people, in local areas, to encourage the readers to take up the opportunity to book a NHS Health Check. Haelo also produced a short film showing a real Salford patient’s views on the health check. Patient stories are a key part of our product portfolio and provide professional results.
  • Simpler and shorter invitation letters were designed and produced which made health checks more accessible to patients. Again the ‘why, how and where’ was clearly outlined in the invite, simplifying and demystifying the process for patients. Practice staff were able to efficiently complete searches for eligible patients, generate the invite letters and record the clinical aspect of the health check. The integration of the process into the new IT system BMJ Informatica meant that this was a fully joined up process; where practice staff were then prompted to deliver relevant health promotion information and link to onward referrals.
  • Opportunistic invitations were identified as another key intervention. Staff and clinicians were encouraged to offer NHS Heath Checks when liasing with eligible residents as part of Learning Sessions.
  • IT system notifications, i.e. alerts on screen, were tested through BMJ Informatica and reminded staff to inform patients about their eligibility for a health check when attending other health appointments.
  • Text message appointment reminders were also identified as a key intervention. This was a cost-effective change and with a device in their hands, those eligible were increasingly able to phone up and request appointments following the intervention.

The Health Checks programme has close links to other Haelo programmes of work, such as the National Diabetes Prevention Plan and Dementia United.


Salford NHS Health Checks Poster male
Salford NHS Health Checks Poster

Effecting a change in population health

 The outcomes of the collaborative

After implementing the changes in 2014/2015, there was a clear increase in the uptake of NHS Health Checks in Salford. Since the collaborative began, those delivering health checks have been working hard to improve uptake. The culture of cooperation and collaborative activity was particularly relevant in this programme.

The work undertaken by Haelo yielded positive outcomes and improvements in uptake of NHS Health Checks particularly in the 2014/15 year to 56.4%. Although the specific target of 60% uptake was not met, there was a significant increase in uptake compared to the previous 2013/14 year.

NHS Health Checks measurement

In 2015/16, after the initial collaborative came to an end, Haelo continued to work across Salford  – managing data related to the NHS Health Checks work; including the dashboard of measures, outcome measures and the quarterly update of data from practices. Haelo continued to monitor and ensure that the NHS Health Checks are of a satisfactory quality and delivered consistently throughout Salford.

Progress was sustained at this level during the 2015/16 year although no further increase was seen. One of the more positive aspects of this programme was the vast amount of partnership work that occurred between various Salford partners paving the way for further joint programmes of work to benefit the Salford population. Other significant improvements were made in regards to increased engagement with primary care, intelligence gathering, collaboration with the Salford City Council, the Salford CCG and Third Sector organisations such as Salford Healthy Communities.


NHS Health Checks goes global

In April 2016, Haelo were invited to attend The International Forum on Quality and Safety in Healthcare Conference.

Representatives from Haelo travelled to Gothenburg, Sweden, to present a Planned Experimentation poster at the Science Symposium, on how planned experimentation could be used to increase the uptake of NHS Health Checks in Salford.


Going forward with NHS Health Checks

As a result of NHS Health Checks now being included in the Salford Standard clinical commissioning framework from April 2016, all GP practices now have an obligation to provide NHS Health Checks to their population. The work completed by Haelo and partners during 2013 – 2016 should assist organisations delivering Health Checks in Salford in meeting the NHS Health Check targets within the Salford Standard.

The Greater Manchester Devolution also provides an opportunity for increased uptake of the NHS Health Checks programme as they fit a major drive to encourage everyone in the region to take charge of their own health: often through prevention and screening plans.

 

Learning from Salford NHS Health Checks

A document review was conducted by the University of Salford. The aim of this review was to explore the outcomes of the 2014-2016 collaboration between Salford City Council (SCC), Haelo and other Salford Partners with respect to improving the uptake of NHS Health Checks.

The outcomes of this project are split into three separate reports: Part A – Executive Summary; Part B – Research Report and Part C – Technical Report. All documents can be viewed on the University of Salford Institutional Depository.

You can find the Executive Response from Haelo and Salford City Council here.


References

[1] See statistics from Public Health England, ‘Salford, Health Profile 2014’. Accessed on 14/05/2015 via http://www.apho.org.uk/resource/view.aspx?RID=142110