HEALTH DIAGNOSTICS

www.healthdiagnostics.co.uk

@healthdiagsltd

NHS Health Check News BY HEALTH DIAGNOSTICS

B erkshire is a county with an array of profound health inequalities across its six local authorities (LAs). Whilst Slough and Reading both rank in the

bottom half of the nation’s LAs in terms of premature mortality, the remaining councils in the area including Windsor and Maidenhead, West Berkshire, Bracknell Forest and Wokingham all feature in the healthiest 15%.

Despite currently ranking as the healthiest LA in the country (1st out of the 150 in England for premature mortality), Wokingham Borough Council’s (WBC) performance on NHS Health Check delivery has historically been low. As Diane Farmer – Public Health Officer for WBC – explained, ‘Diabetes UK queried this with us at the end of March; it was time to do something new and try something different’.

Reflecting on the rationale behind the procurement process they then embarked upon, Farmer described how ‘Wokingham Borough Council members were keen to avoid using private companies to boost health check numbers by bussing nurses into the borough.’ In addition to having ‘no real control’ over the quality of such a

service, Farmer explained how ‘the LA wanted to link in with the council’s economic development team and create employment opportunities for local people interested and able to be involved’.

After considering a range of organisations and consulting public health specialists, WBC decided that ‘Health Diagnostics stood out, particularly given the approach that the council wanted to take’. Whilst the project is still in the relatively early stages, Wokingham have engaged a range of providers to deliver the programme using Health Diagnostics’ fully compliant delivery model. This diverse network of providers includes outreach teams, pharmacies (both independent and in local supermarkets), leisure providers and GP practices. In an effort to further broaden the delivery network, the council have even forged links with the Royal Berkshire Fire and Rescue Service who will be providing health checks in fire stations and at community events.

Expanding the network of outreach providers in this way is not without its risks; a systematic approach is essential to ensuring consistency of delivery across a variety of settings

and providers. This was a key consideration for WBC and, according to Farmer, the system that’s been implemented is ideally suited to achieving this; ‘everyone receiving a check is sitting with someone who’s able to give the same messages and take the same motivational approach’.

In a further effort to make the service work for service-users, WBC’s providers have been supplied with point-of-care equipment; these systems allow all the cholesterol tests to be done in a single session. Reflecting on the problem of splitting the health check over two visits – (in order to wait on pathology test results for example) – Farmer explained that ‘a lot of people dip out if they’re asked to make more than one appointment’. One of the big changes being introduced is therefore that patients will only need one appointment in order to obtain and discuss their results. The delivery method also ensures that providers avoid the risk of missing out on payments for uncompleted health checks.

Article continues on page 4 >

Wokingham Borough Council implement

new NHS Health Check service model

A provider from Tesco takes Wokingham Borough Council’s Public Health Consultant through an NHS Health Check using the local authority’s new system

NHS Health Check News by Health Diagnostics 01

Motivational Interviewing

NHS Health Check News by Health Diagnostics 02

Motivational Interviewing

and the NHS Health Check

W hen it comes to the UK’s heart disease problem, the social and economic costs are dizzyingly high. Every year the condition is

responsible for around 74,000 deaths; the cost to the economy comes in at £29 billion. At the current rate, Britain is spending more of its health budget on heart disease than any other EU country.

Whilst the figures are bleak, many of the risk factors associated with the condition – including high cholesterol, high blood pressure, smoking, inactivity and diabetes – are largely, if not entirely, preventable. According to the INTERHEART study, 90% of the risk factors associated with a male having a first heart attack or stroke are modifiable; the figure rises to 94% for women. This being the case, the simple answer to reversing the trends lies with the not-so-simple process of changing collective lifestyle behaviours. It’s with precisely this preventative agenda that the NHS Health Check programme is concerned.

Despite representing the most comprehensive effort to proactively bring down the national burden of ill health, the success of the programme lies, according to Public Health England (PHE), ‘in part with the ability of the chosen provider to inspire behaviour change in those attending’. To this end, the practice of Motivational Interviewing (MI) has become a central feature of the programme delivery framework.

The inclusion of MI is empirically justified; according to research by Lundahl et al, MI is ‘effective when delivered in brief consultations’ and has the potential to have ‘robust effects across outcomes’ when used in medical care settings. This consensus is perhaps unsurprising however if we accept that health and care are improved when patients are at the forefront of any decision-making. Such patient-centeredness is exactly what effective MI is able to support and enhance.

Integrating MI into the NHS Health Check framework As is emphasised in the accompanying article on The Evidence Base for NHS Health Checks, quality is key to the success of the programme. Whilst a number of factors go in to making a quality consultation – from the professionalism of the provider to the functionality of the systems – on a personal level, they’re fundamentally characterised by engagement, empowerment and respect. As was highlighted during a recent MI workshop for the Health Diagnostics team, these are precisely the principles fostered by a truly motivational session.

The coordinator of that two-day workshop was Brett Nicholls, Chief Executive of Get Berkshire Active and MI trainer. With nearly two decades of experience using MI in his role as an RAF officer, Nicholls brought to the table both a high-level overview of MI philosophy and a host of nuanced insights on how the techniques can be used in different settings. Focusing in on the NHS Health Check, the core objective in this instance was to further develop the ways in which Health Diagnostics support the process of making every contact count.

Working on the principle that ‘people learn best that which they discover themselves’, Nicholls and the Health Diagnostics team explored how the behaviour change techniques originally developed by Drs Rollnick and Miller can be adapted and applied to the context of a 20-30 minute cardiovascular health check. Despite only offering a brief window of opportunity, the reach and availability of the checks mean that people often use them as a gateway to lifestyle change. Whether this change is catalysed by an individual realising what the future may hold for their health, or simply gaining a knowledge of the local support services on offer, many who’ve had a check confirm that the personal discoveries they make cause them to stop, think and very often take action.

How then do we maximise the opportunities

offered by the health check? In short, by an approach that draws out and bolsters commitment to lifestyle change when it emerges in the session. In this regard, a chief finding from the workshop was that ‘the spirit’ of MI should be present right from the point at which the client walks through the door (rather than the provider only thinking within an MI framework when results are being discussed). In other words, the entire consultation should be defined by the understanding that:

Whilst these elements form the backdrop of a motivational approach, a number of specific strategies and skills are on hand to facilitate a discussion about the client’s personal concerns and potential changes. Ranging from asking open and evocative questions that establish the priorities of the person having the health check, to showing attentive engagement by reframing and reflecting client statements, these and other techniques give MI its signature quality. Despite requiring training and practice, when used well, the basic skills can often have the powerful effect of helping individuals connect with the things that are important to them.

A non-judgemental style that favours collaboration, evocation and autonomy will offer the best chance of success.

Motivation to change is elicited from the client, and not imposed from the outside.

It’s the client’s task to resolve their mixed feelings towards their lifestyle behaviours, not the provider’s.

The provider is there to encourage this reflection and offer the tools with which the client can generate insights and pursue their own goals.

Expressing empathy, affirming self-competence and helping to plan next steps are key provider qualities.

Above: A health check provider conducts a motivational session. Below: Geoff Curtis of HD and Brett Nicholls of GBA

Digital publishing

03 NHS Health Check News by Health Diagnostics

As the name Motivational Interviewing would suggest, the techniques are particularly well suited to reinforcing a client’s ability to take control of their lifestyle. Whilst the principle of a ‘non-judgemental style’ is regarded as key to exploring and imparting this confidence, it remains the case that making certain judgements may in fact have the effect of encouraging behaviour change. Although resisting negative judgements is essential to the practice of MI, it should be noted that making the assumption that clients have the capacity to achieve their goals can, in itself, influence behavioural outcomes.

‘‘Preconceived ideas of a certain type may in fact be beneficial. In addition to helping avoid unnecessary resistance and bringing about a constructive conversation, a positive approach that assumes clients have the capacity to change their lifestyles may itself be a factor in bringing about behaviour change’’

Dubbed the ‘Pygmalion effect’, research has found that people may be positively and negatively influenced by the expectations of others. In other words, holding high expectations can positively affect real performance. For the NHS Health Check provider then, preconceived ideas of a certain type may in fact be beneficial. In addition to helping avoid unnecessary resistance and bringing about a constructive conversation, a positive approach that assumes clients have the capacity to change their lifestyles may itself be a factor in bringing about behaviour change.

Whilst maintaining faith in the possibility and benefits of change, the latest research on Evidence-based risk communication by Zipkin et al also underlines the importance that providers are able to ‘effectively communicate evidence’ on the harms of certain lifestyle behaviours. Working on the principle of patient-centeredness, Health Diagnostics has developed interactive tools with which providers can demonstrate to clients their current cardiovascular risk and the effects that any lifestyle change could have.

Intuitive icon arrays, ‘heart age’ calculations and simple-to-understand betting probabilities are used to express both ‘current’ and ‘what if you change’ risk scores to the client. Thanks to these uniquely personal risk calculations, clients are free to draw their own conclusions without providers needing to extol the virtues of a healthy lifestyle. Providers are therefore able to fill the role of supporting and reflecting any concerns, as well as helping to strategise the next steps that clients may be motivated to take.

Whilst this article offers only a snapshot of how MI is being integrated into Health Diagnostics' systems and training, the principles of behaviour change are at the core of a number of exciting software and service developments. If you'd like to find out more about how Health Diagnostics are advancing and enhancing the NHS Health Check delivery model for local authorities, please contact info@healthdiagnostics.co.uk. To find out more details about MI training opportunities contact

brett.nicholls@getberkshireactive.org. HD

Digital learning resources

published online and

freely available

I n a bid to increase access to Health Diagnostics’ library of published materials, a large amount of content was recently made digitally available online. The contents of

this library can be viewed as online magazines on a range of devices including computers, tablets and phones. Having been closely engaged with the national programme since its inception, Health Diagnostics are hoping that these materials enhance the rich array of free NHS Health Check learning resources available. So what’s included in Health Diagnostics’ digital library?

NHS Health Check News

In addition to this issue of the newspaper, the first edition of NHS Health Check News is featured in the library. Released at Public Health England’s February 2014 conference, the paper includes a range of articles that focus on issues such as the latest research and developments in provider competencies. The centerfold features a case study on County Durham’s Check4Life programme and documents how the ‘end-to-end’ solution is being implemented in the North East. The paper can be viewed at: http://bit.ly/1uorK2C

Example Training Materials

This section features the Motivational Interviewing workbook that’s supplied to providers on training days in addition to Health Diagnostics trainers teaching basic MI techniques. The workbook is intended to give guidance and advice on how to encourage constructive lifestyle conversations that promote positive lifestyle change. Whilst Health Diagnostics offer a number of training materials and guides to providers, this workbook is the only example that’s made freely available online for public use. Get in touch to find out more about Health Diagnostics’ range of training resources. The workbook can be viewed at: http://bit.ly/1phzjXK

NHS Health Check Leadership Forum

This report contains the summary and findings from the first NHS Health Check Leadership Forum. Taking place during the 2013 Commissioning Show, public health professionals came together to share learning and experience of NHS Health Check programme delivery. An expert panel presented the findings from a range of local projects and public health researchers reported on the early indications from the national evaluation. The report can be viewed at: http://bit.ly/1DZzb0b

Picture of Health Reports

During 2012 – amid unprecedented changes being made to the commissioning and delivery of NHS services – Health Diagnostics sponsored the production of the Picture of Health reports. This series of three reports and a case study offered clear and comprehensive information on the transition of public health from PCT to local authority control. Produced by Andy Cowper, editor of Health Policy Insight and Achieving Commissioning Excellence, the documents were made up of interviews with experts from around England. They continue to offer unique insights into the commissioning and delivery of NHS Health Checks through local authority. A case study on the North East of England’s service model is included. These reports can be viewed at:

http://bit.ly/1vDM3ED. HD

A risk graphic used in Health Options® to demonstrate an individual’s cardiovascular risk

18.1% 66

Score Heart age

NHS Health Check News by Health Diagnostics 04

Wokingham Borough Council’s new service

> Continued from page 1

Wokingham Borough

Council improve NHS

Health Check delivery

methods with

Health Diagnostics

Going beyond the face-to-face consultation, quality and consistency are key features of the data that’s being captured by WBC’s delivery teams. Using Health Options® software, outreach providers working across the council are able to securely transfer health check data electronically to patient records. This seamless transfer process has significant benefits for all parties involved. For patients, their data is immediately available on their GP’s clinical system should any follow up be required. Providers avoid the cost of printing and posting the results. GP practice staff aren’t required to re-key any data, saving time, money and the potential for error. The commissioner gets near real-time reports and analysis on all transferred data, allowing them to continually monitor local health trends and evaluate the service.

‘‘Health Diagnostics stood out, particularly given the approach that the LA wanted to take’’

Whilst WBC are currently pioneering this joined-up approach within the local authority, there are also developments in the level of integration across Berkshire’s LA borders; ‘there are a large number of people living in Reading that work in

other areas like Wokingham, and vice versa’. Through liaison and collaboration with their Reading colleagues, WBC’s public health leads are seeking to ensure that anyone receiving a health check at their place of work in Wokingham for example, will know that their results can be transferred to their Reading GP. The two councils will also be raising the profile of the local programme by running promotional events at Reading Football Club in conjunction with Berkshire’s Fire Service. Through developing this kind of joint working, the councils are aiming to guarantee that every contact – across the region – truly counts.

What does the patient get?

Regardless of where the patient has their health check, a completely consistent service has been rolled out across WBC. From GPs to outreach providers, the software, structure and overall standard are all designed to conform to the same rigorous specifications.

Constructed in accordance with WBC’s branding, Health Options® software guides both patient and provider through an interactive health check. The test screens are designed to be shared by both individuals and any high-risk lifestyle behaviours are automatically flagged. A host of hints, tips and health information are on hand to aid with any discussions. The software also captures and

securely stores all essential data.

Having gone through the tests that comprise the NHS Health Check, the patient is presented with their CVD risk score. In accordance with the latest evidence on communicating risk, this likelihood of suffering a heart attack or stroke over the next ten years in conveyed to patients through intuitive icon arrays, ‘heart age’ calculations and simple to understand betting probabilities. The health messages that patients receive are therefore far from generic; the harms of certain lifestyle behaviours are communicated on uniquely personal and accessible terms.

“The what if you change tool gives the patient an immediate idea of the potential effects that could result from any lifestyle change”

By way of facilitating a consultation that’s consistent with the principles of Motivational Interviewing (MI), WBC’s providers are able to manipulate a ‘what if you change’ scenario. This tool gives the patient an immediate idea of the potential effects that could result from any lifestyle change; the shared decision-making process is also significantly enhanced as a result.

Patients leave their health check with a detailed personal report that contains their results and tailored information on lifestyle

support services available in WBC. Any individual goals they may have set are also restated in the report and further information is provided on the conditions tested for during the health check.

On the subject of what patients take away with them, Diane Farmer explained that ‘people have said that they feel like they’ve been for an expensive private check thanks to the quality of materials they leave with!’ This was emphatically confirmed at a recent health check event in Wokingham when a client approached the organisers to tell them that she thought they were doing an ‘amazing thing’ and how she hoped it was ‘rolled out more widely; it’s an invaluable service, particularly with people able to take away their personal report and results’.

The effects that quality consultations of this kind can have on peoples’ lives are substantial. Bruce (pictured below) is a particularly glowing example of what’s possible. He had an NHS Health Check when they were first introduced in 2009 and subsequently went from being a heavy drinker and smoker, to running seven marathons in seven days across the Sahara. In his own words, Bruce stated that he’d ‘recommend the check 100% to others. It was a real eye-opener. I completely changed my lifestyle as a result of it’.

For any WBC residents between the ages of 40 and 74 who haven’t got a pre-existing condition and have not had an NHS Health Check in the past five years, the opportunity to get informed and discuss your options is there to be taken.

Bruce before Bruce after

A provider in Wokingham attempts to send a local radio DJ’s blood pressure through the roof

Wokingham Borough Council’s new service

What does the provider receive?

Training WBC’s delivery teams to use the system to conduct patient-centred health checks represented an important early step in the local rollout. Health Diagnostics trainers travelled to the borough to run a number of one-day courses on-site for the groups that would be delivering. Covering the full range of topics – from background CVD theory and accurate testing technique, to operating Health Options® software and using brief MI techniques – the course offered WBC’s providers the overview and detail they need to deliver the programme effectively.

Once out in the field and conducting health checks, the software is full of features that are there to support providers during consultations. From being prompted when a referral may be appropriate, to being able to pull up easy-to-understand ‘help screens’ for support in conveying clear information about what’s being tested, the LA’s providers have a purpose-built tool to help deliver high quality health checks regardless of IT experience. The personal CVD risk graphics are of particular relevance when providers are working with patients to establish lifestyle goals. This shared-decision making process is focused on in more detail in the accompanying article on Moti-vational Interviewing and the NHS Health Check.

In addition to the software’s built-in help screens, Health Diagnostics’ telephone support teams are on hand to respond to any queries and help WBC’s providers with the administrative elements of the service. Essential admin tasks such as safely managing patient-identifiable information and securely uploading this health check data to GP clinical systems are amongst a host of activities that providers are closely supported on. These processes collectively go in to making sure that, as Farmer pointed out, ‘all the data gets round the cycle and everything’s accounted for’.

The software allows for small-scale individual analyses so that providers are able to review their own performance. A much more in-depth and wide-ranging analysis is provided to the commissioner; this is detailed in below.

How is the commissioner supported?

From the start of the set-up period, to the public rollout of the programme, WBC were able to get their project up and running in less than 4 weeks. Responsiveness and flexibility were crucial to Health Diagnostics meeting this tight turn-around deadline. Having worked on NHS Health Check projects since the scheme was introduced in 2009, Health Diagnostics were able to bring to the table substantial experience of delivering on these sorts of requirements. This accumulated learning meant that templates for essential documentation were readily supplied, local demands were swiftly met, and information was on hand as to what has worked in other councils across England.

With only Diane Farmer tasked with the responsibility of orchestrating the implementation of WBC’s programme, a support network was required to take care of the essential, yet time-consuming background configuration. Responding to this need, Health Diagnostics have functioned as the council’s ‘back office’, allowing Farmer to focus on WBC’s public health agenda.

An ongoing aspect of this back office function is that Health Diagnostics provide WBC’s public health directorate with monthly reports containing detailed analyses of provider performance and local health trends. This ability to report on the project, its findings and its effects, is closely related to the electronic patient data transfer process that WBC have put in place. In addition to ensuring that health check data is sent to patient records regardless of the clinical system in use, Health Diagnostics close management of the data means that it can be investigated

and reported to commissioners on an anonymous basis.

Further to monitoring the patient data flowing through the system, WBC’s work force competencies scheme means that project leads have access to information on the number of checks that providers are conducting. Commissioners are also kept informed of how providers are complying with the mandated testing standards thanks to the external quality assurance programme that Health Diagnostics coordinate in conjunction with the Royal Bolton Hospital.

The relationship between Wokingham Borough Council and Health Diagnostics is conceived of as a close partnership; whilst Health Diagnostics provide information, expertise, systems and support, those working within the local authority are freed up to focus on coordinating the local public health strategy. This is the proven method that Health Diagnostics are uniquely able to offer. For more information about the ways in which it has been successfully deployed in countless areas across England,

contact info@healthdiagnostics.co.uk. HD

‘‘From the start of the set-up

period to the public rollout,

WBC were able to get their

project up and running in less

than 4 weeks’’

Berkshire’s Royal Fire and Rescue Service deliver NHS Health Checks from the mobile unit pictured above

05 NHS Health Check News by Health Diagnostics

‘‘Get Berkshire Active are a strategic sports

and physical activity partnership passion-

ate about increasing participation. We’re

part of an inspiring national network and

are available to help Berkshire’s PH and LA

teams deliver their health and wellness

physical activity priorities.’’

Brett Nicholls, CEO, Get Berkshire Active

T he debate as to whether NHS Health Checks represent value for money was given renewed impetus towards the end of 2014 when two new studies into the programme were published in the Journal

of Public Health and the British Journal of General Practice.

The first of these – a cohort study by Forster et al published in October 2014 in the Journal of Public Health – used a significant sample of patient data (65,324 men and 75,032 women) ‘to estimate the yield of NHS Health Checks’ and assess the programme’s impact. The conclusions of this large-scale study were that the ‘universal prevention programme identifies substantial risk factor burden in a population without known cardiovascular disease’. In other words, NHS Health Checks are effectively revealing CVD risk factors in a large proportion of the 40-74 year old population that were previously presumed to be healthy.

Despite the weight of these findings, those calling for the programme to be abandoned appear to have paid little attention to them. The same however cannot be said for the amount of attention that critics gave to a recent study by Caley et al – published in August 2014 in the British Journal of General Practice – which claimed to assess ‘the impact of NHS Health Checks on the prevalence of disease in general practice’. The authors of this study assert that in 38 GP practices providing NHS Health Checks, the change in reported disease prevalence did not differ from 41 practices that did not provide the checks.

Whilst the programme’s detractors have cit-ed this as evidence that the health checks should be scrapped, a number of researchers and clinicians have since pointed out that Caley et al’s study was, in fact, ‘not powered to support this conclusion’. In addition to there being concerns over the methodology and conclusions, further questions have been raised as to whether those calling for the national programme to be abandoned are basing their arguments on evidence that doesn’t accurately reflect the reality of what’s happening on the ground.

As Dr Matt Kearney – GP and National Clinical Advisor to Public Health England and NHS England – and others have identified, the study was ‘not randomised’, which may explain

why it was underpowered to show an increase in disease prevalence. Perhaps more problematic however is that fact that researchers formed conclusions after having considered conditions that are not routinely included in the NHS Health Check.

Despite the authors examining the prevalence of ‘hypertension, coronary heart disease (CHD), chronic kidney disease (CKD), atrial fibrillation (AF), and diabetes’, as Dr Kearney and others note, CHD and AF are not assessed in the national programme. Although in the longer term you would expect CHD to fall if the health checks proved effective, this would take longer than the three year time frame that the study was confined to.

‘‘Rigorous randomised controlled trials into the NHS Health Check programme do exist.’’

This highlights a particular recurring issue in the debate; calls to abandon the health checks have often relied on research that doesn’t relate to the current model put forward by Public Health England (PHE). This was similarly found to be the case with the 2012 Cochrane Review, the conclusions of which the Department of Health say have ‘little if any relevance to the NHS Health Checks’. There are a number of reasons for this, one of which was that most of the trials considered were out of date, some from as long ago as the 1960s.

Whilst a number in the health sector have identified Caley et al’s most recently published non-randomised study as lacking the evidence to justify its conclusions, rigorous randomised controlled trials (RCTs) into the NHS Health Check programme do exist. One such study monitored population changes in CVD risk factors over the first year of a new NHS Health Check service. This study by Cochrane. T et al concluded that the programme resulted in a ‘significant reduction in estimated population CVD risk’.

Furthermore, this study established that NHS Health Checks which incorporate Motivational

Interviewing and ongoing tailored lifestyle support ‘significantly reduce the prevalence of central obesity’. Given that the UK has been found to currently have the highest prevalence of obesity among adults in Western Europe, this insight into the value of high quality consultations is of particular concern. Fortunately, the evidence sug-gests that the programme currently promoted by PHE – which is fundamentally conceived of as a supportive and motivational lifestyle intervention – will represent an important component in tackling the nation’s obesity problem.

For any public health agenda that takes seriously the notion of patient-centeredness, an essential consideration must clearly be the perspectives of patients themselves. As Janet Krska et al found from carrying out a study that investigated patients’ views and experiences of the NHS Health Check, ‘both attenders and non-attenders had positive views towards NHS Health Checks in general practice and resultant self-reported lifestyle change in attenders was high’. For this to be the case however, ‘clear written information and explanation of personal CVD risk are required’. In other words, the quality of the consultation and support should be noted as repeatedly surfacing as the key to coordinating a successful programme.

Whilst a number of the aforementioned studies firmly support the value of conducting NHS Health Checks, a nation-wide evaluation is yet to be completed. A forthcoming study by Imperial College London however will address specifically that issue by evaluating whether the national programme ‘reduces the burden of heart disease and stroke and other vascular diseases while reducing inequalities in them.’ In addition, researchers are investigating the effect of providers delivering patient-focussed health checks that ‘extend beyond ticking the contractual boxes’. As has been emphasised in this article, (and as many in the sector would affirm), assessing the quality of health checks must be a fundamental consideration for any meaningful

evaluation. HD

References and links to the studies cited in

this article can be found at http://

bit.ly/1yhVNIu >

Reviewing the

evidence base for

NHS Health Checks

Evidence base

NHS Health Check News by Health Diagnostics

With vocal opposition claiming that

the national programme lacks the

evidence to support it, we examine

the outcome data featured on NICE’s

online ‘Evidence Search’ portal.

Above: NHS Health Check branding and the front page of NICE’s online ‘Evidence Search’ portal

06

Provider focus

NHS Health Check News by Health Diagnostics

Provider Focus: Bewick Crescent Surgery

07

I n this issue of NHS Health Check News we focus in on Bewick Crescent Surgery, County Durham. Having recently revamped their health check service, the surgery conducted

almost six times as many health checks as they had done prior to implementing their new approach. Bewick Crescent Surgery is now amongst the top performing GP practices in the local authority for the delivery of NHS Health Checks. We caught up with Tracy Fleming – the surgery’s NHS Health Check lead – to find out what the team had done to turn their service around.

Q: What was it about Bewick Crescent’s previous approach to delivering NHS Health Checks that wasn’t working well?

A: Our doctors were telling people that they needed an NHS Health Check, but we found that people often weren’t turning up to their appointments despite having been booked in. This meant that we were often allotting time that ended up being wasted when patients didn’t attend. We also found however that when patients were in a less formal situation – with the healthcare assistants for example – they would often have the confidence to say ‘well actually I don’t want one’. We recognised that taking advantage of this would allow us to be far more efficient with our time and resources.

Q: How did you take advantage of this and alter the service?

A: I’ve taken it upon myself to start asking people as they come in. For example, a patient might feel unwell and come into the surgery for a blood test; if they’re eligible I’ll ask them if they’re interested in having a health check and, if so, book them in there and then. I’ve found you tend to get a much better response when the person is in front of you. For us, it works better than sending out letters that you might not get a reply to.

Q: So does Bewick Crescent Surgery not send out invite letters?

A: We do send invite letters, yes. With those people that we can’t get on the telephone to make an appointment, we send a letter informing them of the service and asking them to ring us if they’d

like to book in for a health check. Instead of saying ‘come in at this time on this day’ – which we’ve found doesn’t really work – those that are interested get in touch and those that aren’t don’t ring back. This just allows us to be more efficient and not waste our time with unattended appointments.

Q: It sounds like efficiencies are at the heart of a lot of the changes?

A: Yes, that’s true; the fact that I’ve taken a leadership role in delivering the service has made that easier. Patient-centeredness is also really important. We’ve made sure that patients come first and any changes work for them. For example we’ve introduced a Tuesday evening clinic that runs between 5pm and 7.30pm.

Q: What was the rationale for putting on this out-of-hours service?

A: We put on the evening clinic to accommodate for those people that wanted to have a health check but who weren’t able to get the time off work during the day. It means that we’re engaging a large number of people that we wouldn’t otherwise get to see. It’s been really well received by patients, as has the quality of the health checks that we’re delivering.

Q: What is it about your health checks that patients appreciate?

A: Health Options software is a lot nicer and more patient-friendly than the software we used before. I tilt the screen so that I’m not talking at the patients, but instead we go through the process

together. They can see what I’m doing – I don’t hide anything – and I use the on-screen info to help explain things to them. In that sense, the computer becomes more of a shared focal point; patients therefore don’t feel as though they’re being spoken at, they’re actively involved in their health check.

Q: And what do people leave with after their health check?

A: Everyone gets a colourful personal report in a folder; this is another thing that’s really well received. The reports are full of good information on blood pressure, cholesterol, weight management etc, as well as containing the patient’s results. Often people don’t grasp everything that’s said to them when they come into a doctor’s surgery but with this, they’re able to go home and digest the information at their leisure. The report also contains a graphic that clearly explains the individual’s heart age, cardiovascular risk and the potential effects of lifestyle change. This tends to have a much more powerful impact that just saying ‘stop smoking’ or ‘eat healthily’.

Q: Do you see the health checks having an impact then?

A: Yes, we’ve had a number of patients take up our smoking cessation service after having had their health check. People are also very interested to learn about the different types of cholesterol – HDL (good) and LDL (bad) – and what they can do about their levels. I’ve found people leaving saying ‘I didn’t realise eating more fruit and veg and stopping smoking could make the difference’. There have also been individuals like a man we had in recently who was quite fit – on his bike all the time – but the health check revealed he had dangerously high cholesterol levels. When he looked into his family history, he saw that high cholesterol was a hereditary trait that he hadn’t known about. This was something he was then able to address.

Q: What sorts of things are you doing to pro-mote the service?

A: We have a big Check4Life banner and notice board in the waiting room with leaflets that patients can take away. These tend to catch peoples’ eye. The notice board clearly says who’s eligible so people can make appointments while they’re waiting if they’re interested. We also include stuff for kids – things like the Check4Life activity wheel – as we’ve found that if the kids start getting into it, it can help mum and dad to keep moving. Word of mouth within families is also a really powerful way to promote the service. We have a lot of people saying ‘This is brilliant, I need to my husband to have one’. A lot of wives actually book their husbands in whilst they’re here

and make them come down! Thanks Tracy. HD

Top Tips from Bewick Crescent

Have someone take the lead on the service

If people in the surgery are interested and eligible in having a check, book them in there and then

Use patient-friendly software and systems and share the screen

Adapt to patients’ needs and put on evening clinics if necessary

Advertise the service and involve kids in lifestyle change programmes

Tracy Fleming takes a patient through a health check using Health Options® software

The end to end solution

NHS Health Check News by Health Diagnostics 08