TY - JOUR T1 - Health checks and screening: what works in general practice? JF - British Journal of General Practice JO - Br J Gen Pract SP - 493 LP - 494 DO - 10.3399/bjgp14X681637 VL - 64 IS - 627 AU - David Mant Y1 - 2014/10/01 UR - http://bjgp.org/content/64/627/493.abstract N2 - I know that prevention is better than cure but it’s still the bit of general practice I have always enjoyed least. It’s hard to be motivated by something not happening. It’s easier to be motivated by screening, where the aim is to detect early-stage disease and there is often compelling evidence for the effectiveness of treatment. But GP enthusiasm for prevention has been dampened by ill-conceived NHS policy initiatives since at least 1990.1 Dalton et al 2 are not the first to ask whether NHS Health Checks are defensible when measured against World Health Organization screening criteria.3Enthusiasm for health checks will be further dampened by two other studies in the BJGP. Caley et al 4 reported that they have surprisingly little impact on the recognition of undiagnosed diabetes, hypertension, chronic heart disease, chronic kidney disease, or atrial fibrillation. Koekkoek et al5 point out that the evidence favours targeted stepped interventions, which avoid investing scarce resources in the worried well. And the evidence from all three articles is consistent with the Cochrane meta-analysis which makes it quite clear that promoting health checks in unselected adult patients has limited impact on cardiovascular risk and no significant impact on cardiovascular mortality.6However, it is important not to throw out the baby with the bathwater. Many of the constituent elements of health checks (for example, smoking advice, blood pressure management, and statin prescribing) are trial-proven effective interventions. The studies by Korhonen et al 7 and Gil-Guillen et al, 8 as well as Caley et al, 4 confirm that population screening in primary care can detect undiagnosed cardiovascular risk. So what … ER -