EVALUATION OF NHS HEALTH
CHECKS PROGRAMME IN
CAMBRIDGESHIRE (November
2009 to March 2010)
Janet Watkinson
NHS Health checks programme lead
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Cambridgeshire at a glance
• Cambridgeshire population 610,000 (2010)
• Percentage of population within 40-74 years 41%
• 1% of population in Cambridgeshire lives within 20%
most deprived areas of England (2007)
• Health inequalities exist in Cambridgeshire. There is
a 5 year difference in life expectancy for males
between least and most deprived areas in the county.
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Population distribution by deprivation
quintiles
NHS Cambridgeshire (formerly Cambridgeshire PCT)
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The programme
• DH recommended implementation of NHS
Health checks programme for people aged 4074 years from 2009/10
• Selection criteria applied
• Early identification of people with high risk of
developing cardiovascular disease
• By taking a history, examination and a simple
blood test
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
NHS Cambridgeshire programme
• There was no existing systematic
cardiovascular risk detection programme
• A completely new initiative for the PCT
• The initial implementation was through GP
practices
• With intention of broadening the range of
providers i.e community pharmacies
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Local target
• 12,000 health checks from April 2009 to
March 2010
• Involvement of 8 GP practices to deliver the
programme
• Learning lessons from the initial phase and
then roll out into a wider programme of
call/recall health check and
referral/intervention from 2010/11
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Objective
• To identify any areas that needs to be
improved for future implementation
• Identify areas of good practice
• To give the service provider an opportunity to
give a useful feedback on programme delivery
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Methods
• All 8 practices participated in delivering NHS
health checks in Cambridgeshire were engaged
in evaluation
• Questionnaire was used to gather both
qualitative and quantitative information
(Questionnaire was designed with the input of
GP lead and NHS health checks steering group
members)
• Questionnaire completed by each practice and
returned by end of April 2010
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Methods contd.,
• Qualitative information: Experience of those
delivering the programme, feedback on service
delivery, patient perception and suggestions for
improvement.
• Quantitative data: Number invited,
demographic profile, number of people with
newly detected risk factors, number of high
risk people and number of non attendees
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Results
• Response rate:
– Qualitative part 87.5% (7/8)
– Quantitative part 100% (8/8)
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Overall programme implementation
• 6/7 practices: very good or satisfactory
implementation
• Reasons:
–
–
–
–
Good IT system
Help from the local PCT
Proper organisation and planning
Working with local resources and people (e.g
Traveller groups, Bangadeshi population)
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Risk assessment of the patients
• Problems identified
– Difficulty in motivating well and hard to reach
people (3/7)
– Lack of near patient testing (3/7)
• Solutions
– Open days to encourage people (1/7)
– Discussions with local trust regarding near patient
testing (2/7)
– Employing extra nursing time (3/7)
– Interpreter service for Bangladeshi population
(2/7)
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Risk management of patients
• Problems
– Lack of consultation time (3/7)
– Language barrier (2/7)
– Lack of near patient testing resulted in loss to
follow up (3/7)
• Solutions
– Late run surgeries (2/7)
– Development of leaflets in different languages
(2/7)
– Use of recall system to prevent people from loss to
follow up (1/7)
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Suggestions to improve service delivery
• Availability of near patient testing
• Flexible service provision
• Pre defined outcome measures and data
required for monitoring and evaluation
• Increasing the level of communication to the
public
• Organising a clear patient pathway within the
practice
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Key learning points
• Consider the role of near patient testing
• Be open minded (think out side the box) about how to
reach the target group
– Use of existing and established systems to
approach hard to reach
– New innovative approaches (open evenings)
– Local publicity
• Establish local systems to avid loss to follow up
• Evaluation and data collection should be upfront
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Outcomes achieved
• Total number of health checks completed
between 1st November 2009 to 31st March
2010 was 2403
• Target for the study period 2180
• Coverage 110%
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Number of patients seen against the target
by practice
700
Number of people
600
Number of completed health
checks
Target for the period
500
400
300
200
100
0
Practice Practice Practice Practice Prcatice Practice Practice Practice
1
2
3
4
5
6
7
8
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Percentage of risk factor detection
(n=2403)
Risk factor
Number
Percentage
At least one risk
factor
Hypertension
994
41.4
353
14.7
Obesity
626
26.1
Diabetes
11
0.5
Kidney disease
4
0.2
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Percentage of people detected with
hypertension and obesity by practice
60
Hypertension
Obesity
48.9
50
45.3
40
29.9
30
26
25.4
24.4
21.9
26
24.8
22.8
19.2
20
14.8
14.7
10
5.4
3.1
2.8
3
0
Percentage
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
L
T
O
T
A
8
ra
ct
ic
e
7
P
ra
ct
ic
e
6
P
P
ra
ct
ic
e
5
P
rc
at
ic
e
4
ra
ct
ic
e
3
P
P
ra
ct
ic
e
2
e
ra
ct
ic
P
P
ra
ct
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e
1
0
Percentage of people with 20% CVD
risk within next 10 years by practice
60
56.2
50
P
e
r
c
e
n
t
a
g
e
Percentage
40
31.1
30
22.2
18.8
18.7
20
13.3
9.9
10
8.6
7.9
0
Practice
1
Practice
2
Practice
3
Practice
4
Prcatice Practice
5
6
Practice
7
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Practice
8
TOTAL
Demographic profile of high risk patients
• 51.6% were between 60-69 years of age
• 81% were male
• 84.7% White British
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Risk factor management
• Out of all the health checks completed
– 230 (9.7%) referred for smoking cessation
– 156 (6.6%) referred to exercise referral
schemes
– 2250 (94.9%) given life style advice
– 140 (5.9%) were put on medication
– 23 (1%) referred for further testing
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Number and percentage of eligible
people who did not attend the health checks
Practice
Number invited No did not attend
1
127
54 (42.5)
2
638
7(1%)
3
373
3(0.8%)
4
327
206 (63%)
7
164
101 (62%)
8
185
20 (10.8)
Total
1776
384 (22%)
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Demographic profile of DNAs
• Just under a half (48.6%) of DNAs were young
between 40-49 years of age.
• In the 60-69 age group, the age group with
highest CVD risk, 27% did not turn up for
their health check.
• 57% of those who did not attend were male
and 80% were White British
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Recommendations
• Provision of near patient testing to minimise loss to
follow up
• Good communication and awareness raising of the
target population using media and PCT
communication system.
• Use existing systems and developing innovative
methods to encourage hard to reach population,
young people and working population. This could be
achieved using nurse led afternoon clinics, week-end
clinics or clinics at the work places.
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Recommendations contd.,
• Annual evaluation of the programme to
identify strengths and weaknesses of the
programme. The method of evaluation and
type of data to be collected must be agreed
with the programme implementers at the
beginning of the implementation
• Continuous learning from the programme
implementation
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
So What……………..?
• Sharing evaluation findings
– Published as a case study in the web
– National networking workshop
• Availability of near patient testing
• Sharing good practice through workshops and
training days
• Including evaluation as part of the programme
• Principally targeting 20% most deprived
practices
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
Acknowledgements
• Dr Gina Radford, Chair NHS Health Checks
steering group
• All GP practices delivered the NHS health
checks programme in Cambridgeshire and
responded to this evaluation.
• NHS Cambridgeshire Health Checks Steering
Group members .
NHS Cambridgeshire (formerly Cambridgeshire PCT)
Visit our web site: www.cambridgeshire.nhs.uk
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