This was a retrospective observational 5-year study, from 2009 to 2014, on an open cohort of patients eligible for an NHS Health Check, based on data routinely collected and anonymised in GP electronic health records in City & Hackney, Newham, and Tower Hamlets CCGs. All but four of the 143 local general practices used the same web-enabled health record (EMIS Web), covering 98% of the 950 000 locally registered patients. The other four practices undertook NHS Health Checks, but they used a different computer system and were unable to provide study data.
How this fits in
The NHS Health Check programme was successfully implemented in three east London clinical commissioning Groups (CCGs), with support including performance dashboards, managed practice networks, and financial incentives. Attendance was higher in the most deprived quintiles and among South Asian people. The finding that statins were 40% more likely to be prescribed to attendees than non-attendees is an intervention of public health importance with considerable room for further improvement. Replicated nationally, statin use resulting from NHS Health Checks would prevent an estimated 4600 to 8400 heart attacks, strokes, or death from these causes in 5 years. New comorbidities were 30 to 80% more likely to be identified in attendees than matched non-attendees and their treatment is likely to add to the impact of this programme.
Patients eligible for an NHS Health Check were aged 40–74 years, without pre-existing vascular disease, hypertension, familial hyperlipidaemia, chronic kidney disease (CKD), diabetes, or current statin prescription. In 2015, the Clinical Effectiveness Group at Queen Mary University of London extracted patient-level data for eligible patients during the period 1 April 2009 to 31 March 2014. Attendance was recorded once, as this is a 5-year rolling programme.
For those registered with the practice on 1 April 2009, eligibility and entry into the cohort were assessed on that date. For patients who registered after 1 April 2009, eligibility and entry were set as the date of registration. Eligibility was reassessed each year on 1 April. The index date for attendees was the date of the NHS Health Check, and for non-attendees it was 1 April each year (or later date of registration).
Attendees to NHS Health Checks were eligible patients with a Read code 38B1 or 8BAg denoting attendance, recorded 1 April 2009 to 31 March 2014. Non-attendees were those eligible on 1 April of each year and did not have these codes recorded in that year. Townsend deprivation scores were grouped into quintiles based on national distributions. Self-reported ethnicity was grouped into census categories. Coverage was reported as number of attendees divided by one-fifth of the eligible population in that year, expressed as a percentage.
In City & Hackney and Tower Hamlets CCGs, the practice payment for each NHS Check attendance was partly incentivised, based on achieving targets for uptake and for statin prescription in patients at high CVD risk. In Newham, a flat fee was paid. In Tower Hamlets, and to a lesser extent City & Hackney, patients at highest CVD risk were invited first, but invitations in Newham were not targeted in this way. Finally, Tower Hamlets used managed practice networks to support implementation and target achievement.34 Because of these differences in implementation, the authors report the three CCGs separately, and in combination.
