SECURE DATATATATAT

FLOW

SECURE DATATATATAT FLOW

SECU

REDATATA

ATATFL

OWSECURE DATATATATAT FLOW

StopSmoking

Get Active

Weight Management

2.Deliver

a Health Check

4.Data

Transfer

3.Public Health

Reporting

Secure centralised data storage.

Anonymous reporting to Commissioner

Stop

1.Identify & Invite

Cohort IdentificationRisk Stratification

NHS Health Check NewsBY HEALTH DIAGNOSTICS

HEALTH DIAGNOSTICSwww.healthdiagnostics.co.uk @healthdiagsltd

01NHS Health Check News by Health Diagnostics

The End to End Solution for NHS Health Checks

he North East is well known as being an area of relatively poor health compared to much of the rest the country, with

the majority of the region ranking in the lowest third of England’s local authorities in terms of premature mortality.

Despite the national inequalities, a number of health improvement programmes in the North East have taken bold steps towards tackling the problems. One of the most widely-recognised local authorities in this regard is County Durham; an organisation that was recently featured by The Guardian as a prime example of what can be achieved with a fl exible and progressive approach to primary care. With the full end to end solution being implemented, County Durham is pursuing the gold standard in CVD prevention infrastructure. The fi nal

piece of the jigsaw will go into place in March 2014 when the local authority add Health Diagnostics’ cohort identifi cation and invite distribution process to their current Check4life NHS Health Check programme. With an extensive and varied network of providers working across County Durham, profi cient data management and transfer was always going to prove crucial to the programme’s success. Health Diagnostics has ensured that the data generated by each and every health check delivered in the community is securely

T

Implementing the gold standard

in CVD prevention infrastructureP4

returned via the N3 network to all types of GP clinical system. This data populates the individual patient records with limited administrative involvement, other than the GPs agreeing to accept the results.

Continue to page 4 to read the the full story on County Durham’

County Durham implement the end to end solution for NHS Health Checks

Heart disease

Kidney disease

Stroke

Diabetes

Dementia

Free NHS Health CheckHelping you prevent heart disease, stroke, diabetes, kidney disease, and dementia.

2900902 NHS Health Check Leaflet v0_4.indd 1 20/03/2013 15:21

Your Personal Health Report

02 NHS Health Check News by Health Diagnostics

iven 2013’s confl icting headlines in regard to NHS Health Checks, providers of the programme have

understandably been confused and frustrated by the inconsistency of the messages being reported in the press. On 21st July 2013, Public Health England (PHE) announced a drive to extend the national health check programme and widely praised its potential to ‘save up to 650 lives a year’.Less than a month later on 20th August, the Times ran with the front page headline ‘NHS checks on over-40s condemned as ‘useless’’, with an accompanying article that focussed on a study from the Nordic Cochrane Centre. The study alleged that health checks don’t have an impact on morbidity.

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Health Diagnostics respond to criticism from the Cochrane Collaboration

Response to criticism

Both of these claims cannot be true at the same time. The pressing question is therefore: which is accurate and relevant to the English NHS Health Check programme? One of the major criticisms of the Cochrane Review is that it doesn’t actually apply to the NHS Health Check model put forward by PHE. According to the Department of Health’s (DH) response to the Cochrane Review: ‘Most of the trials considered are old, dating from as long ago as the 1960s when understanding of health risks and particularly how they may be modifi ed was at an early stage of development. Most of the risk reduction measures now used post-date these trials.’ As a result:‘The review’s conclusions can have little if any relevance to NHS Health Checks.’The current approach championed by

PHE is – fi rst and foremost – a targeted lifestyle intervention that’s designed to encourage positive behaviour change in individuals with poor health habits. The logic is that through the eff ective communication of risk and appropriate service referral, individuals can fully grasp their likelihood of having a heart attack or stroke and, if needed, be off ered support to do something about it. Health Diagnostics have seen countless case studies of individuals in which this is exactly what’s been achieved. Moreover, the NHS Health Check is unique in the fact that it combines a number of elements and tests – all of which are ‘based on evidence of clinical and cost eff ectiveness from trials’ – and brings them into a single risk assessmentprogramme. As Dr Bill Kirkup, retired Chief Medical Offi cer at the Department of Health, noted, ‘none of the trials assessed by Lasse Krogsbøll and colleagues tested this’. As many public health experts would agree, dialogue is essential to ensure thatpublic health programmes such as the NHS Health Checks are worth the money that’s spent on them. The issue in this instance is that recent criticism has rested on research that does not accurately refl ect or relate to what’s happening on the ground. From an academic perspective, it’s essential that the studies being used in evidence are not disconnected from the reality of the situation. A further criticism of the NHS Health Check has been that the programme constitutes ‘a waste of money for asymptomatic people’; a statement which translates as ‘if you’ve not already developed complications, you shouldn’t be receiving a health check’.

In response, public health experts have appropriately drawn attention to the burden of ill health that threatens to overwhelm the NHS during the comingdecades. PHE’s offi cial statement written by the organisation’s Medical Director -Dr. Paul Cosford – focussed on the programme’s deliberately preventiveemphasis, stressing that early detection is key to helping people improve theirlife expectancy and quality of life. It is for precisely these reasons that the programme targets lifestyle factorsassociated with preventable diseases before they become unsustainably costlyfor the individual concerned and, on a larger scale, for the NHS itself.

One needs only to look at the facts staring us in the face. It has been estimated that by 2050, ‘90 per cent of today’s children will be overweight or obese.’ Even by 2030, ‘Three in four adults are likely to suff er illnesses such as heartdisease or diabetes’ according to the Daily Telegraph’s article from the 21stAugust; a publication that only the day before ran with the story about healthchecks being ‘useless’. Specifi cally in terms of diabetes, treating the condition currently costs the NHS £1.5 million an hour. Given the other estimates, the direction in which this fi nancial burden is likely to move looks bleakly clear. The net fi nancial benefi t of acting whilst there’s an opportunity to do so has hard evidence associated with it. As Barbara Young, Chief Executive of Diabetes UK stated to the BBC:‘Once you factor in the savings in healthcare costs, the NHS Health Check is actually expected to save the NHS about £132 million per year.’ Furthermore, research published in the BMJ on the 13th May 2011, found conclusively that:‘A programme across the entire population of England and Wales... that reduced cardiovascular events by just 1% would result in savings to the health service worth at least £30m a year compared with no additional intervention.’ As a result, once the evidence is examined and objectively considered, the claim coming from the programme’s critics that the Cochrane Centre’s fi ndings constitute the ‘best available evidence’ seems to look less and less empirically accurate. The fi gures and guidance informing the Department of Health’s approach are all published and freely available online at: www.gov.uk/government/publications/nhs-health-check-implementation-review-and-action-planFollow us at @healthdiagsltd

“the NHS Health Check is actually expected to save the NHS about £132 million per year.

”

The research

03NHS Health Check News by Health Diagnostics

uestions over measurable outcomes have been a consistent feature of the NHS Health Check debate since the programme was rolled out in

2009. Given the scope and ambition of the service, articles calling for evidence have become a regular feature in public health journals. Fortunately, research is increasingly emerging and constructively informing the debate. When considering the evidence, it’s essential to bear in mind that despite the

Q

Evaluating Leicester City’s Healthy LifeCheck programme

Evaluating Sefton’s cardiovascular screening programme

Research into evidence for pharmacy-delivered NHS Health Checks is published

programme being nationally mandated, there’s no single mandated way of delivering it. The systems in use across England vary substantially in terms of the emphasis they place on design, user-friendliness, and encouraging lifestyle improvement. The studies cited in this article all use a patient-focussed solution developed by Health Diagnostics. Although Health Diagnostics’ systems are used in a variety of settings – from GP practices, to community delivery health buses – the studies here focus on delivery via pharmacy.

Health Diagnostics provide the full range of point-of-care equipment for the delivery of accurate health checks in a single session!

All equipment supplied with full warranty, training materials, quality assurance scheme and commissioner reporting. All associated consumables available next day delivery. Call off scheme and tracking of usage provided.

This evaluation focussed on a service that was delivered by community pharmacists in Leicester City. In the introduction to the research that was published in the Journal of Public Health in March 2013, the rationale for evaluating the pharmacy-led programme is explained: ‘‘In the past, risk screening programmes have been exclusively undertaken within primary care sites. It has been suggested that such an approach may widen health inequalities by excluding those who do not routinely access organized health care…

This study was carried out by the School of Pharmacy and Biomolecular Sciences at Liverpool John Moores University. It engaged 10 pharmacies delivering the NHS Health Check programme and was published in June 2010.

Subsequently, emphasis has been placed on the importance of incorporating second sector organizations in delivering a vascular risk assessment service.’’ This work therefore assessed precisely how important it is to have a ‘many-pronged’ approach when tackling local health inequalities. The study involved a sample of 2,521 individuals, which were recruited from 39 pharmacies.

The report makes the following comment in regard to the collated views on the pharmacy CVD screening service:‘‘Almost all of the participants had a positive experience of the screening process, with 96 (99.7%) agreeing that they were given enough time for the screening and that pharmacists made them feel at ease. Similar high numbers felt comfortable discussing their lifestyle with the pharmacist. Indeed for many, their expectations of what the screening would cover were exceeded. A further 91 (93.8%) participants agreed that the screening had been done in a suitable place. However, nine (10.8%) had

questions that were not discussed during their consultation.’’ Seeing empirical research confi rm that NHS Health Checks are being well-delivered by providers outside of GP practices is dispelling the myth that targeted lifestyle interventions can only be carried out by doctors.

Given the strain that GP’s are under, as well as the pressing need to raise awareness about the importance and practicalities of leading a healthy lifestyle, looking to the secondary sector should really be something for local authorities across England to consider. For further information or a localised appraisal of the potential impact of extending the provider network, contact Health Diagnostics at info@healthdiagnostics.co.uk or on 01244 311811. All reports are produced using evidence-based economic modelling.

“99.7% of participants had a positive experience

”

“The current study demonstrates the suitability of a pharmacy-led system

”

© Health Diagnostics Ltd 2009. V7/9

NHSSefton

Sefton NHS fact sheets 2/7/09 13:57 Page 13

In short, the conclusions to the study spoke resoundingly in favour of pharmacy’s ability to identify and engage with people that may otherwise slip under the radar:‘‘Cardiovascular risk assessment led by community pharmacists can successfully assess people from large, multi-ethnic UK populations and identify those at high cardiovascular risk or with undiagnosed cardiovascular disease.

The service may improve rates of assessments undertaken by individuals who do not access health care through traditional routes.’’ By way of a comment on the particular advantages off ered by pharmacy, the study’s authors noted:‘‘The current study demonstrates the suitability of a pharmacy-led system in including those from a minority ethnic background; perhaps due to the extent to which pharmacies are integrated within local communities and their ability to provide information in a number of languages and formats.’’ The complete study may be accessed at: http://jpubhealth.oxfordjournals.org/content/early/2013/03/11/pubmed.fdt017.abstract

04

Health check deliverySince its inception in 2009, the project has grown substantially and now incorporates a vast network of NHS Health Check providers. As well as inviting at-risk individuals for a health check, County Durham’s providers also widely engage in opportunistic screening. Known as the Check4Life programme, the emphasis of the health checks is fi rmly placed on ‘‘promoting lifestyle change, giving people choice, and empowering them to make decisions.’’ Jacqui Deakin – Health and Quality Improvement Lead for County Durham and Darlington NHS Foundation Trust – has overseen the expansion of the area’s programme and places particular attention on making sure the teams access Durham’s most disadvantaged communities. In order to target areas within the county’s top 30 per cent deprivation percentile, Deakin and her colleagues run road shows and community events in areas of high footfall. Following liaison with local ambassadors to establish areas that are most in need of help, the Check4Life teams deliver the health checks using Health Diagnostics’ portable system. Because all Durham’s providers use this system to deliver NHS Health Checks, (as well as the majority of local authorities in the North East of England), everyone is initially trained by Health Diagnostics’ professional trainers. Those in charge of running the training scheme explain, ‘‘everything we do strictly adheres to best practice guidance. When the data is coming into GP practice from the community delivery teams, being able to rely on providers’ technique is absolutely key.’’

In addition, Health Diagnostics are about to release an online video made in conjunction with the Check4Life teams that will off er a comprehensive overview of everything involved in delivering quality consultations using point-of-care equipment.

See p.6 of NHS Health Check News for details.

The end-to-end solution in County Durham

NHS Health Check News by Health Diagnostics

The complete solution

Overview of the process in practice

From identifying the cohort, to delivering health checks and returning data to any clinical system, we explore how County Durham is working towards a seamlessly integrated primary care pathway.

1. Identify and invite:The fi rst link in the delivery chain involves County Durham’s commissioners determining precisely which members of the local population are to receive invites for an NHS Health Check. By running queries against the GPs’ clinical database, public health can determine the specifi c cohort they intend to target. Offi cial letters are then generated and sent to the identifi ed individuals inviting them for a health check. By targeting people expected to have a CVD risk of 20% and above, County Durham will be able to take specifi c measures to increase uptake of the programme amongst their most vulnerable groups.

2.Deliver a health check:Upon attending their health check, the invited individual’s details are securely imported into Health Options®; CVD risk assessment software supplied and supported by Health Diagnostics. After completion, the anonymised patient data is securely sent over an encrypted network to Health Diagnostics’ data centre where it’s collated and analysed.

3.Public health reporting:Health Diagnostics can thus produce detailed reports of local health trends and provider performance. These are delivered to County Durham’s commissioners on a monthly and quarterly basis, allowing them to make fully informed decisions in regard to local public health policy.

4.Data transferOnce analysed, the patient data is returned to the GP clinical systems securely via the N3 network. This can occur regardless of the clinical system used by the GP practice; all types are seamlessly compatible with the process. To avoid any duplication, the person is marked as having received an NHS Health Check.

As well as being launched in GP practices in March 2014, County Durham deploy a diverse network of providers to deliver the checks.

StopSmoking

Get Active

Weight Management

StopSmoking

Get Active

Weight Management

StopSmoking

Get Active

Weight Management

StopSmoking

Get Active

Weight Management

Stop

Single session health assessmentsWith research demonstrating that half of attendees don’t show up for a follow-up appointment when health checks are delivered in two parts, County Durham’s public heath authority have been keen to ensure that delivery occurs in a single session. The use of approved point-of-care equipment is the eff ective way to facilitate this. As well as being signifi cantly cheaper (35% according to Dr. Shane Gordon’s research), single session delivery importantly means that that the patient gets the full benefi t of the ‘risk communication’ session. Giving individuals the opportunity to hear their results and discuss their lifestyle there and then is crucial way to infl uence behaviour change and signpost to other local services. Recognising the importance that NHS Health Checks function as eff ective brief interventions, programme leads in County Durham have insisted that providers take time to explain the results. Local feedback has confi rmed that the local populations have appreciated this:

“What service users say“Very pleased I attended as the check revealed I have AF. Subsequent to the check an ECG confi rmed this. Medication has been prescribed and an appointment for an echocardiogram is in the pipeline to be arranged. Many thanks”

“I think these are a great opportunity to get checked out. The length of time taken to see a doctor is far too long and puts people off from going so this is a great way to get to know if you’re in good health or not”

“Coming here and speaking to the staff has motivated myself in changing my lifestyle”

”

NHS Health Check providers using Health Options® in County Durham- GP practices- Health Improvement Service- Durham County Council- Check4Life team- Pharmacy- Leisure Works- Pioneering Care Partnership

County Durham patient satisfaction levels for NHS Health Checks- 483 patient experience questionnaires completed- 82.2% were very satisfi ed with the NHS Health Check- 99.6% would recommend a NHS Health Check to other people

Continued from page 1

05NHS Health Check News by Health Diagnostics

The complete solution continued

Effective brandingSo as to take advantage of familiar touch points, the look and feel of the events deliberately mimics the government’s national Change4Life campaign. Deakin explains, “we incorporated many of the marketing themes of the national Change4Life campaign into our Check4Life promotion to take advantage of a recognisable brand that was already embedded in people’s awareness.” This branding is used throughout Durham in any location that the health checks are available. There’s even a mobile health bus that’s able to penetrate into the heart of the communities where they’re most needed.

Returning data to all GP clinical systemsAs was recognised by Public Health England in their 10-point action plan for the NHS Health Checks, recording data ‘‘on community practice systems has been a challenge – this has to be done in order to count towards targets.’’ Due to the wide variety of clinical systems in use across England, developing a consistent method of patient data transfer that’s secure and reliable has become something of a holy grail for the country’s public health authorities. Health Diagnostics have worked hard with their partners to make this a reality. Patient data can now be safely sent from

providers using Health Options® to all types of GP clinical system, with the information populating the individual patient record. Fundamentally, the process means that GPs save time and money, are electronically supplied with accurate data, and can focus on providing patients with swift access to local services. The sum total of this means that Durham’s GPs are increasingly able to get on with the task of administering the highest standard of care.

Quality assuranceThe issue of quality assurance and provider competency was raised as an important area of concern in Public Health England’s 10-point action plan. From the perspective of County Durham’s commissioners, if GPs were to accept the results of health check data obtained by ‘‘any qualified provider’’ into their clinical systems, it was essential for the solutions supplier to develop a standardised delivery format that would guarantee accuracy. Insofar as provider competency is concerned, Health Diagnostics provide an accredited training programme that conforms meticulously to the best practice standards set by NICE. This training has ensured consistency across those delivering in County Durham in regard to background CVD theory, delivery technique and use of the IT solution. Once these individuals qualify, Health Options® is able to track how frequently they use the programme. This information is shared with the commissioners in order to determine whether, for example, refresher training is required to boost the skill set of certain users. Despite the fact that no governing body has yet put in place mandatory standards to ensure cholesterol analysers are routinely checked to be performing correctly, Health Diagnostics has worked collaboratively with the Royal Bolton NHS Foundation Trust to design such a scheme. County Durham, as well as all other providers using Health Options®, are automatically signed up to this when they begin delivering health checks. Those public health authorities partnering with Health Diagnostics are therefore safe in

the knowledge that their programmes are administered in conjunction with a Foundation Trust that have won awards for their ‘Efficiency in Clinical Support Services’ from the likes of Health Service Journal.

Data analysisHealth Diagnostics provide County Durham with monthly and quarterly analysis reports, giving the commissioners and service leads all the information they need to make informed decisions on local CVD prevention policy. The reports collate an anonymised dataset and provide statistical analysis on the demographics of the population tested, along with a full breakdown of the health parameters tested during a health check. These parameters include blood pressure, cholesterol results, lifestyle factors (smoking status, alcohol consumption, and physical activity) BMI, and CVD risk, and are all classified as ‘low / medium / high’ risk accordingly. Additionally, Health Diagnostics supply County Durham with in-depth analyses of the number of clients signposted to lifestyle services and those referred to their GP for further investigation. As well as offering insight into the health of the local population, the reports give a comprehensive overview of how well the various health check sites are performing. A particularly useful element to the reports has proved to be the inclusion of performance league tables of health check sites. These are compiled alongside details of how many consumables are being used by each site across the county. Julie Evason – MD at Health Diagnostics – explains, “this means that the commissioners are in a position to enquire into what’s going on if certain sites are getting more consumables than they are delivering health checks. The service adds another vital quality assurance element to the programme.’’ The combination of all of these performance indicators has allowed County Durham’s heads of public health to increasingly refine their approach to targeting vulnerable and ‘hard to reach’ populations. As a result, the local authority has made huge progress towards identifying the most efficient methods for delivering a high volume of health checks in their locality.

Mini Health MOTsNot long after County Durham began delivering NHS Health Checks in 2009, the county’s heads of public health found that uptake varied markedly in terms of patients’ age, gender and socioeconomic profile. Dr Mike Lavender, a Consultant in public health medicine in County Durham, explains:‘‘There was a huge variation in terms of health checks being delivered by GP practices, so we knew we had to do something in the communities which the practices weren’t reaching. That was

the first step. We also saw that men and women in the younger age-groups (40s to mid 50s) really weren’t going in for the health check. This isn’t particularly surprising for that age group, as they may not see heart disease as particularly being a problem. They may be working, they can’t get time off etcetera, so the scheme was to be aimed at that younger adult population.’’The response came in the form of a community programme that targeted the younger populations by offering a ‘Mini Health MOT’ to those aged 16 to 40. Dr Lavender explains that by broadening the age bracket, “You’re accessing people at the teachable moment, as well as maximising all the effort and investment that has gone into training the staff who deliver the service.” The pilot used Health Diagnostics’ services and support and achieved the following outcomes:- 3378 people accessed a Mini Health MOT- 483 clients were eligible for a full NHS Health Check- 418 clients in total were signposted to lifestyle intervention services, including: - 113 to physical activity - 64 to local stop smoking services- 183 to the health trainer team - 58 to healthy cooking courses.

“Client testimonial Jacqui Deakin – Quality and Health Improvement Lead for County Durham and Darlington NHS Foundation Trust – talks about her experience of working with Health Diagnostics:

‘‘Health Diagnostics has been pivotal in delivering Check4Life in County Durham. We commission the organisation to deliver training, provide the equipment, support the quality assurance, and supply all the IT systems; the complete end to end solution in other words.However I prefer to see Health Diagnostics as colleagues and partners. Yes, we commission the services, but we also work very closely together. Without that team effort, we wouldn’t have been able to achieve what you see going on across County Durham now. It’s a two-way process, a partnership; you couldn’t have one without the other.As an organisation, they’re the most ‘can-do’, flexible team I’ve ever known. They’re absolutely fantastic to work with.’’

”

06

I

Motivational Interviewing techniques used during NHS Health Checks

NHS Health Check News by Health Diagnostics

Behaviour change

For those involved in the NHS Health Checks, maximising opportunities to engage with people and promote healthy living is a basic concern. With meaningful and motivational consultations widely recognised as crucial to the programme achieving the impact it promises, the central question for commissioners and providers is ‘how can really ensure we make every contact count?’

n reality, the process of encouraging individuals to consider behaviour change is a delicate task. However, having constructive conversations can be greatly assisted by practicing certain Motivational Interviewing (MI) techniques.

A central idea of MI is that individuals are far more likely to be convinced by their own arguments than those imposed by others. As such, the method looks to elicit an individual’s inner motivation to change. Above all, eff ective MI depends on a non-judgemental attitude that facilitates a conversation that’s relevant to the concerns of the person having the health check. Achieving these objectives is possible through a combination of techniques outlined by Miller and Rollnick in MI-3. How-ever, given the specifi c circumstances off ered during a health check, brief interventions often need to be – as their name would suggest – brief. As such, delivering a 20 minute counsel-ling session is often not possible. The question for health check providers is then, ‘how can we make a diff erence in the min-utes that are available to us?’ In order to provide guidance on precisely this matter, the teams at Health Diagnostics have produced a pack of train-ing and consultation materials. These are provided to anyone trained at a Health Diagnostics training day. Due to the time pressures during a NHS Health Check, us-ing visual tools as a support is an invaluable way to encourage behaviour change. With this in mind, Health Diagnostics have built a number of tools into Health Options® in order to aid the user in explaining and eliciting information about lifestyle. Targeted use of these tools is covered in the MI pack mate-rials, as well as being featured in a short fi lm documenting the fi ndings from the NHS Health Check Leadership Forum that ran in conjunction with the 2013 Commissioning Show. This fi lm can be accessed online at: www.healthdiagnostics.co.uk With Health Diagnostics delivering an MI module as part of the NHS Health Check training, as well as directing providers to e-learning resources available on the NHS’s Professional Learning Environment, there are fresh answers being given in response to the fundamental question; ‘how can we make every contact count?’

The pack includes:

01A booklet that condenses the techniques outlined in MI-3 into a framework for approaching NHS Health Check consultations

02A range of Top Tip cards which may be used by practitioners to off er bite-size practical advice on lifestyle choices

03Access to a video demonstrating some of the MI techniques in action

New NHS Health Check training videoService users talk about their experience March 2014 is set to be a signifi cant month for the NHS Health Check campaign, with the release of the JBS 3 cardiovascular prevention guidelines and a series of comprehensive new training videos for providers and service users. Featuring full-length consultations, the training videos will off er providers an invaluable insight into what best practice looks like in action. The individuals carrying out the checks are all experienced Check4Life providers who’ve been responsible for delivering a consistently high volume of checks for a number of years. In addition, the materials – which will be freely available on YouTube – will serve as an information source for any member of the general public interested in fi nding out what having a check is all about. With the health checks being real as opposed to staged, the videos capture the impact that eff ective, non-judgemental consultations can have. Keith and Bruce, two men that received consultations as a part of the project had only positive things to say about their experiences:

Bruce, 40 years old, from Durham:

Bruce was given a health check by Dawn from John Low’s Pharmacy in Consett, County Durham: ‘‘It was really interesting. I actually came for a health check fi ve years ago when the scheme was fi rst being introduced and functioned as a bit of a guinea pig for the pharmacists to train on! The results I got today are phenomenal in comparison to last time. When I came fi rst time around, I was leading a completely diff erent lifestyle to what I am now and it was a real eye-opener when I saw my results. I was

drinking a huge amount more than I am now and I was a heavy smoker as well. As a result of the health check, I put a stop to both these habits and began eating a lot healthier. In short, the health check had an extremely positive impact, so much so that I’ve since been able to complete a number of Ironman challenges and am planning to race seven marathons in seven days across the Sahara this year! I couldn’t even run to the pub fi ve years ago! Even last time, I remember Dawn being really professional and very non-judgemental in her style. Today was no diff erent, I felt very relaxed and comfortable. I’d recommend it 100% to others. Five years ago, I thought that I was pretty healthy because my job’s always been fairly active. It turned out that I really wasn’t doing enough though. In fact, because of my lifestyle I was building up real problems for myself. My results today have confi rmed that I’ve been able to turn all this around.’’

Keith, 55 years old, from Durham: Keith was given a health check by Nicola of County Durham’s Check4Life team:‘‘From the greeting onwards, I thought the whole thing was really professional.Nicola explained everything really well for me and I understood precisely what was going to happen. What was quite surprising was how I wasn’t being judged in any way, shape or form. I wasn’t told I was fat, drinking too much or not exercising enough, Nicola just gave me the information and let me make my own judgement about it. The health check has certainly given me the evidence and incentive to make more changes to my lifestyle. I’d defi nitely recommend it to anybody; there’s nothing to be frightened of. Even the fi nger-stick sample is nothing really. The thing is, it lets us fi nd out how we are because we don’t know what we’re like inside until somebody helps you to see what you are.’’

Having Motivational Lifestyle Conversations

Health Diagnostics LtdChatham HouseDee Hills ParkChesterCH3 5AR

Phone: 01244 311811Email: info@healthdiagnostics.co.uk Twitter: www.twitter.com/healthdiagsltdwww.healthdiagnostics.co.uk

A workbook providing guidance on using Motivational Interviewing techniques during a NHS Health Check.Intended to offer practitioners advice on how to have constructive conversations that encourage positive lifestyle change.

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At first it felt like I was making sacrifices but once I got a bit more adventurous with the spices I didn’t miss the old foods at all

It’s really satisfying to know that what I’m now consuming isn’t

full of chemicals

We find sitting down together to have a

meal is enjoyable and a great time to catch up on everyone’s day

10Top Tips for Healthy Eating

I felt much better that I was feeding the kids healthy foods and not creating problems for them in the future

Aim to build up to 30 minutes of moderately intense activity per day. Short 10 minutes sessions all add up and if you are in a sedentary job, make sure you get up and walk around at least every hour.

Be prepared for bad weather, carry an umbrella and wear shoes that are comfortable to walk a reasonable distance in.

Use stairs instead of lifts and escalators.Complete everyday household tasks and chores with vigour.

Look into joining a sports club or fitness class. Exercising with others can make it a more social occasion and enjoyable.

Enquire about subsidised ‘cycle to work’ schemes. Many employers run these.

Be active on your commute, walking and cycling whenever possible.

Enquire about showering facilities and locker space in your workplace.

Get off the bus or train a stop earlier and park further away from the supermarket.

Ask whether your employer has a subsidised gym membership scheme or a sports and recreation club. And don’t forget to check out your local authority services which can often be used on a pay per use basis.

““ “““““““““““““““““““““““““““““Top Tips for Physical Activity“10

Ok, do you mind if we discuss your smoking?

And you told me earlier on during the physical activity questionnaire that you’re a freight driver and work a lot of nights. A demanding job... Ok, perhaps you could tell me a bit about how you feel about the amount you’re currently smoking? You said before that you have around 20 cigarettes a day?

Great, well why don’t you tell me a bit about your smoking habits?

So family members have been showing some concern?

Ok, so smoking’s been a part of your life for a long time, there’ve been times in the past when you’ve gone smoke-free, but it sounds like smoking is functioning as a bit of a support mechanism at the moment?

And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical And you told me earlier on during the physical

Great, well why don’t you tell me Great, well why don’t you tell me Great, well why don’t you tell me Great, well why don’t you tell me Great, well why don’t you tell me

Well I suppose my smoking.

It does yeah, but I think I need it at the moment, my jobs quite stressful you see.

Yes, we can discuss it.

Well it’s quite a bit. It could be worse but the amount I smoke has been creeping up recently. My wife’s noticed too.

Well I’ve smoked for years, since I was in my teens. I’ve given up for periods before but it de� nitely helps me cope with the stresses of my job.

T/O: What the practitioner has done predominantly so far is to ask Mark to identify which lifestyle factor is most important to him. Mark’s identifi ed smoking. During a brief intervention or when offering brief opportunistic advice, it’s likely to be easier if you have a single focus.

The practitioner has refl ected back what he’s said to show that they’re listening attentively. An example of this is when the practitioner refl ected that Mark’s

perhaps using smoking as a bit of a support mechanism, that it’s been part of his life for a long time and that there have been times when he’s been smoke-free. When Mark’s expressed some ambivalence and stated that he thinks he needs it, the practitioner has rolled with the resistance, hopefully defused it and re-focussed the conversation towards what he thinks about the amount he currently smokes. Mark’s subsequently revealed some of his family’s opinions.

21

The Script

Bruce before Bruce after

f GPs are to accept the results of health check data obtained by willing providers such as pharmacy, or any qualifi ed provider’ into their

clinical systems, a standardised format which guarantees accuracy is essential. All Health Diagnostics’ LA partners are supplied with a quality assurance programme that is administered in conjunction with the Royal Bolton NHS Foundation Trust. The Bolton Quality Assurance Scheme (BQAS) involves Bolton sending out a serum sample every month to all participating sites using cholesterol testing units supplied by Health Diagnostics to test that both operator and analyser are performing to the required standard. In the words of Gilbert Wieringa, Consultant Biochemist at the Royal Bolton Foundation Trust,

f the 20 pharmacies delivering the health checks across the London borough of Hillingdon last fi nancial year, a

standout performer was Ruislip Manor pharmacy. The person responsible for driving the CVD assessments is Rishi Verma, the pre registration student at the pharmacy. Out of all the health checks conducted in the pharmacy last year, the overwhelming majority were done when Rishi began working in the pharmacy and took it upon himself to champion the health checks. ‘Every interaction is an opportunity’ Rishi explained; ‘delivering the health checks can be really rewarding and they’re great for building patient rapport... Crucially, if you off er someone good care, they’ll keep coming back to you.’ The impact of a member of staff taking responsibility for the checks underlines how important strong leadership is at every stage of health check delivery. Regardless of if you’re commissioning the service or delivering the checks, the success of the programme depends hugely on energised individuals taking the reins.

I

O

Quality is key

Delivery in Hillingdon

07NHS Health Check News by Health Diagnostics

Quality and performance

Delivering NHS Health Checks with Hillingdon’s enterprising pharmacists

“Quality assurance is likely to become a commissioning requirement should high street settings wish to provide services to NHS patients. By insisting now, Health Diagnostics are putting the foundations in place

”

County Durham, for example, ensure all their qualifi ed providers sign up to a strict code of practice which is detailed in their Service Level Agreement (SLA). The expectations are clearly detailed and include:

• Accurately follow the QA of all testing equipment • Attend refresher training and clinical supervision • Sign up to their waste management protocol • Have necessary monitoring and audit processes in place • Have GPs trust that the data is accurate

In addition to assuring that all testing equipment and health professionals meet

‘It’s about creating an atmosphere of positivity and opportunism’ said Rishi‘The pharmacy team all got on board and found potential patients in the client group. This gave us a good cohort to target. Additionally however, if anyone comes into the pharmacy and they’re over the age of 40, I let them know that there’s a brilliant scheme to help them fi nd out their risk of developing cardiovascular disease. What surprises a lot of people is if I tell them that the same test done privately could cost the upwards of £80.’Rishi admits that he’s obsessively driven to do the best he can possibly achieve; so much so that he’s taken it upon himself to go round local businesses handing out leafl ets during his lunch hour. One particularly motivating factor was identifi ed as a training day that was run by Health Diagnostics last year. ‘We were really enthused by the meeting in which the agenda was set and the staff trained’ explained Rishi. Having championed the checks at Ruislip Manor and completed a university project on public health which fi t closely with the NHS agenda, Rishi has accumulated some valuable learning. For those providers who are looking for advice on how to boost numbers, Rishi has a series of recommendations:

the necessary standards, a quality thread runs right throughout every aspect of Health Diagnostics’ delivery model. From the back offi ce support – rated “excellent” by the majority of users – to the accredited training of those delivering the checks, the quality of each element is crucial to the overall standard of the service.

The Royal Bolton QA Team

Over the last month, pharmacy staff rolled out big plans and hosted community events in Hillingdon. With this February being “love your heart month”, the team ran health promotion and awareness events at four libraries across the borough. Sanjay Doegar – the pre registration tutor at Ruislip Manor – described how ‘many eligible Hillingdon residents are unable to fi t in a conventional visit to a healthcare professional. It’s those people that have really welcomed this opportunity to learn more about their health and risk of cardiovascular disease.’ Rishi added, ‘the libraries have community targets to meet. If we come in and deliver the assessments for a day; all they need to do is promote the event.’If pharmacy is to ‘stand up and be counted’ in the reformed NHS – as Chemist and Druggist magazine put it – this kind of innovative and ambitious approach will need to be exploited by pharmacists everywhere. And with PHE aiming to do 15 million NHS Health Checks, the opportunity is certainly there for those that want to make a name for themselves and their business.

Top Tips to Recruit1. Mention it to anyone and everyone that looks eligible

2. Have yourself a ‘pitch’ at the ready

3. Stick your individual pharmacy stamps on the leafl ets so that people register your venue as the place to get checked

4. Word-of-mouth can work wonders. Tell people to inform their loved ones who may be eligible

5. Pharmacies can use MURs to determine eligible clients

6. Maximise any community events that go on in the area. Ruislip pharmacy, for example, do well off the back of the local fun day that runs twice a year where local businesses open up a stall on the main street

www.healthdiagnostics.co.uk @healthdiagsltd

MAKE EVERY CONTACT TRULY COUNT!Health Options® for delivering motivational face-to-face health checks

Heart disease

Kidney disease

Stroke

Diabetes

Dementia

Free NHS Health Check

Helping you prevent heart disease, stroke,

diabetes, kidney disease, and dementia.

2900902 NHS Health Check Leaflet v0_4.indd 1

20/03/2013 15:21

Your Personal

Health Report

Dementia

Free NHS Health Check

Helping you prevent heart disease, stroke,

diabetes, kidney disease, and dementia.

Your Personal

Health Report

© HEALTH DIAGNOSTICS LTD 2014. V8.60

BLOOD PRESSURE1. THE FACTS

What is blood pressure?The heart is a muscle about the size of your fi st. It pumps blood around your body and needs a certain amount of pressure to do so. The blood is carried away from the heart in a network of tubes called arteries. Arteries are elastic, meaning they expand and contract. Blood pressure is measured in millimetres of mercury (mmHg) and is represented by two numbers e.g. 120/80 mmHg.

Systolic blood pressureAs the blood is pumped out, it pushes against the walls of the arteries causing them to expand. The point at which the pressure in the arteries is at its highest is called the ‘systolic’ blood pressure. When measured, a typical resting value might be 120.

Diastolic blood pressureThe heart then relaxes ready to fi ll with blood again and the arteries contract to move the blood around the body. As this happens, the pressure in the arteries drops. The point when it’s at its lowest is called the ‘diastolic’ blood pressure. When measured, a typical resting value might be 80.

What affects blood pressure?The pressure at which the blood is pumped around the body is dependent on:

• The strength of the heart muscle• The condition of the arteries• Organs such as the kidneys that regulate blood pressure

Blood pressure can be measured using a manual or a digital blood pressure monitor, whilst seated. Up to 3 measurements may be taken.

Changes in blood pressureBlood pressure can change throughout the day. Factors such as physical activity, stress and anxiety, stimulants such as caffeine and nicotine as well as illness and certain medications can cause a temporary change in blood pressure. Blood pressure is normally lowest during sleep.

The heart relaxes and refi lls and the arteries contract and move the blood around the body

Blood is squeezed out into the arteries.

Check your pulse Measuring pulse rate can be a good indicator of health. Typically the fi tter the individual, the more effi cient the heart muscle and the lower the heart rate. An irregular pulse rhythm and/or a very high or very low resting pulse can all be indicators for heart disease.

An average resting pulse is generally between 60 and 100 beats per minute. However, there are normal reasons why your pulse may be slower or faster. This may be due to your age, level of fi tness, caffeine, stress, anxiety, medications or illness including heart conditions.

TIP

Insulin

Insulin

1 single measure of spirits

1 small glass of sherry

1 small glass of of wine

Half pint of regular beer, lager or cyder

1 single measure of aperitifs

TIP

Insulin

Insulin

1 single measure of spirits

1 small glass of sherry

1 small glass of of wine

Half pint of regular beer, lager or cyder

1 single measure of aperitifs

© HEALTH DIAGNOSTICS LTD 2014. V8.60

BLOOD PRESSURE

What is blood pressure?The heart is a muscle about the size of your fi st. It pumps blood around your body and needs a certain amount of pressure to do so. The blood is carried away from the heart in a network of tubes called arteries. Arteries are elastic, meaning they expand and contract. Blood pressure is measured in millimetres of mercury (mmHg) and is represented by two numbers e.g. 120/80 mmHg.

Systolic blood pressureAs the blood is pumped out, it pushes against the walls of the arteries causing them to expand. The point at which the pressure in the arteries is at its highest is called the

When measured, a typical resting value might be 120.

Diastolic blood pressureThe heart then relaxes ready to fi ll with blood again and the arteries contract to move the blood around the body. As this happens, the pressure in the arteries drops. The point when it’s at its lowest is called the ‘diastolic’ blood

When measured, a typical resting

What affects blood pressure?The pressure at which the blood is pumped around the body is dependent on:

• The strength of the heart muscle• The condition of the arteries• Organs such as the kidneys that regulate blood pressure

Blood pressure can be measured using a manual or a digital blood pressure monitor, whilst seated. Up to 3 measurements may be taken.

Changes in blood pressureBlood pressure can change throughout the day. Factors such as physical activity, stress and anxiety, stimulants such as caffeineand nicotine as well as illness and certain medications can cause a temporary change in blood pressure. Blood pressure is normally lowest during sleep.

The heart relaxes and refi lls and the arteries contract and move the blood around the body

Blood is squeezed out into the arteries.

Check your pulse Measuring pulse rate can be a good indicator of health. Typically the fi tter the individual, the more effi cient the heart muscle and the lower the heart rate. An irregular pulse rhythm and/or a very high or very low resting pulse can all be indicators for heart disease.

An average resting pulse is generally between 60 and 100 beats per minute. However, there are normal reasons why your pulse may be slower or faster. This may be due to your age, level of fi tness, caffeine, stress, anxiety, medications or illness including heart conditions.

© HEALTH DIAGNOSTICS LTD 2014. V8.60

CARDIOVASCULAR 1. THE FACTS

What is Cardiovascular Disease (CVD)?It is estimated that over 60% of today’s most common diseases are linked to the way we live our lives and many of these diseases are preventable. These diseases include; coronary heart disease (CHD), strokes, cancers, diabetes, kidney disease and some forms of dementia.

What are the risk factors?There are many risk factors linked with developing cardiovascular disease (CVD). These include:• Age• Ethnicity• Gender• Family History• Diabetes

Some of these cannot be changed, but there are a number of lifestyle factors which can be modifi ed to lower your risk of developing CVD and certain forms

of dementia. These include:• Not smoking• Being physically active• Maintaining a healthy body weight• Drinking within sensible limits

When a person’s results are put into a CVD risk assessment calculator, it is possible to predict the likelihood of that person suffering a cardiovascular event i.e. a heart attack or stroke, over the next 10 years. The more risk factors a person has, the higher their risk of developing the disease.

DrinkingDrinking for many is an enjoyable part of life and research suggests that, in moderation, it can have a positive impact on health. However, when taken to excess, alcohol is harmful.

What is a unit?The classifi cation of what a unit is varies throughout Europe. The UK classifi cation is:

However, be aware that strong lager and beer can have twice as many units as standard lager and beer. ‘Home measures’ of spirits tend to be doubles and often triples! What is safe drinking?Although the guidelines are shown as daily

limits, you should aim to have 2-3 alcohol free days in the week. You can’t carry over unused units to another day. Drinking twice the daily recomendation is classed as ‘binge’ drinking and is harmful to your health.Alcohol is fattening!Alcohol is empty calories, has no nutritional

value and is fattening as it contains 7 calories per gram; only slightly fewer than fat which has 9 calories per gram.

• Smoking status• Blood pressure• Cholesterol levels• Being overweight or obese• A diet high in saturated fats

TIP

Insulin

Insulin

1 single measure of spirits

1 small glass of sherry

1 small glass of of wine

Half pint of regular beer, lager or cyder

1 single measure of aperitifs

Gp Referral V5.Docx

NHS Health Check Administration

Read2

NHS Health Check invitation

Provider

NHS Health Check completed by 3rd Party*

NHS Health Check invitation

Referred to GP

Family History

Result Read2

Family History of Angina Male <55

Female <65

Family History of MI Male <55

Female <65

Family History of CVD Male <55

Female <65

Family History of Stroke

Family History of Diabetes

Family History of Hypertension

Family History Unknown - adopted

Test results

Result READ2

Height

Weight

BMI

Advice about weight

Signposting to weight management

Audit C score

Audit score

Lifestyle advice regarding alcohol

GPPAQ physical activity index:

Signposting to Physical Activity Service

Lifestyle advice regarding exercise

Smoking status

Number smoked

Ready\Thinking\Trying to give up smoking

Smoking cessation advice

Sitting Systolic BP

Sitting Diastolic BP

Total Cholesterol

HDL Cholesterol

TC/HDL Ratio

QRISK2 Calculation

General lifestyle advice

Raised Dementia awareness (ages 65-74)

*This is a new Read code issued in October 2012 and may not be available on all systems

initially. If not, please use this substitute:- CVD risk assessment by third party

38B10

000000

n/a

n/a

Miss Test Client

Result

Result

This is a new Read code issued in October 2012 and may not be available on all systems

000000

Gp Referral V5.Docx

Client Name

Client Date of Birth

Client address

CVD Risk Category

Dear Doctor,

As part of the free NHS Health Check programme, your patient recently received a free NHS

Health Check from a trained health professional at our pharmacy and has agreed to share

the results with you. Enclosed are the results for your records and appropriate action. The

patient has been provided with lifestyle advice and information about support services

available locally.

Based on the Health Check results I have also provided the following referral advice to the

patient (marked with a tick below):-

I have advised the patient to make a routine appointment at your practice for further

investigation based on:-

CVD risk score>20%

BP> 140/90

BMI>30

TC>7.5 or TC/HDL ratio>6

I have advised the patient that they should attend for another NHS Health Check in five

years time.

Please do not hesitate to contact me if you require further information.

Yours sincerely,

Dr Simon Jones

Family Medical Centre

1 High StreetCityCountyCC1 1CC

Miss Test Client

01/01/19701 Main RoadChesterCH1 1CH

✔

✔

✔

The Pharmacist

Healthy Pharmacy

1 High StreetChesterCH1 1CH

Miss Test Client

Health Options® CVD risk assessment software contains the latest tools for delivering a fully compliant

NHS Health Check and is confi gured to local requirements.

Demonstrate the impact of positive lifestyle change on CVD risk. Show in an instant how risk can be improved

with simple changes.

Health Options® prints the personal results directly into the pre-printed full-colour fact sheets in seconds!

The report contains the current results and hints and tips on how to improve personal health

and wellbeing.

Health Options® can generate prompt referrals, whether to the clients GP or any of the other services

on offer in the local authority. Documents can be printed, emailed from Health Options® or can be sent securely to

any GP clinical system.

QUICK SIMPLE MOTIVATIONAL

CALL AND RECALL (C&R) SERVICE

FIND INVITE DELIVER RECALL

StopSmoking

Get Active

Weight Management

15 16 17 18

22 23 24 25Stop

Smoking

Get Active

Weight Management

15 16 17 18

22 23 24 25Stop

Smoking

Get Active

Weight Management

Stop

15 16 17 18

22 23 24 25Stop

Smoking

Get Active

Weight Management

15 16 17 18

22 23 24 25

LATEST SERVICE ADDITION

1. Identify eligible patients from existing GP records2. Risk stratify the cohort to allow for a targeted approach3. Generate the invite letter and secure posting4. Deliver a patient focused NHS Health Check5. Return data to the practice clinical system6. Track responders and non-responders7. Minimal practice intervention

Health Diagnostics Ltd Chatham House Dee Hills Park Chester CH3 5ART: 01244 311811 E: info@healthdiagnostics.co.uk W: www.healthdiagnostics.co.uk @healthdiagsltd

The Call and Recall service reduces duplication of input and enables a seamless process, whilst maintaining confi dentiality. All records remain within GP practice.Health Options® must be installed at the practice to perform the C&R process.