Leicester City Council has a good track record of delivering NHS Health Checks. The public health team take every opportunity to publicise them to local communities. They are currently exploring how digital technology could complement the existing offer.
The challenge and response
Leicester is well above average in terms of the percentage of eligible population receiving an NHS health check. The city was sixth on the England comparison table in 2022/23.
Leicester City Council commissions NHS Health Check delivery through an open authorisation scheme, which providers can add themselves on to subject to appropriate requirements. All 57 GP practices offer the checks, though at differing volumes. The rolling authorisation scheme is relatively straightforward for the public health team to manage; colleagues in finance handle the payment reconciliation.
Leicester benefits from some very engaged primary care networks (PCNs) that are committed to maximising NHS Health Check delivery. Some of the city’s ten PCNs operate a hub and offer extended hours opening, with checks available on weekends to anyone registered at a GP practice within that PCN. This ensures that people can access the service at a time and place that suits them.
Laura French, Leicester’s Public Health Consultant, said: “Our contract allows these hub practices to deliver to any eligible person registered with a practice in that network. As well as being convenient for our residents, this spreads the load across the PCNs.”
In the past year, the team have focused on data analysis to really dig into who is (and is not) taking up the offer, and to improve equity of provision and reduce health inequalities. They have been working with Leicestershire Health Informatics Service (LHIS) to improve the use of data around the NHS Health Check process, along with other public health workstreams.
This work has included improving the extraction of data on the number of Health Checks completed, which has helped to ensure payments are accurate; and looking at the quality of information recorded during the Health Check, helping to ensure that checks are thoroughly completed.
Laura French said progress had been slower in terms of obtaining detailed retrospective data. “We all underestimated the complexity of extracting and managing that data, but we are getting there. It will be really useful to know whether we are genuinely getting a cross-section of our city in for NHS Health Checks.”
Leicester has a diverse population and there are areas of significant deprivation. “The plan is to look at who is/is not taking up the offer, at the smallest geography that our data systems can manage, before looking at what we can do to improve that.”
Community events
There is greater potential for delivery which is yet to be explored, Laura French said, such as NHS Health Checks being hosted by community partners. “We have a really valuable network of community and voluntary sector partners, who are interested and engaged in the health and wellbeing of their particular communities. However, community delivery requires infrastructure, such as remote access to systems, that we don’t currently have in place.”
The team takes every opportunity to promote NHS Health Checks at community events. One ambition is to integrate them with other community activity – taking them out on the road to community events and women’s health hubs, for example. “The link between the change in cardiovascular risk status and menopause status requires a different approach to risk stratification and management, so there is a link with our women’s health hub work. A way of performing mobile Health Checks in the community is something we would like to explore.”
Looking ahead
The team is also looking at how digital technology could complement the NHS Health Check without putting people at risk of digital exclusion. Dan Hallam, Public Health Commissioning Manager, said: “We are looking at the idea of a part-digital and part in-person Health Check. A pre-questionnaire could include some of the non-clinical demographic information that takes time to complete. Having some of the template already filled out would help GP practices, which do face a challenge with capacity.”
There are concerns that the national one-size-fits-all approach to NHS Health Checks does not work in everyone’s interests. Laura French said: “As with any intervention, we really need the flexibility at a local level to work with our communities to do things in a way that best meets the needs of local populations.
“Financial constraints mean we do have to make difficult choices about spending, and this limits our ambition in terms of the NHS Health Checks programme. However, Health Checks form a statutory function of the public health grant and are a valuable opportunity for upstream prevention, so we will continue to work to ensure the best use of this opportunity.”
Contact
For further information contact Laura French, Consultant in Public Health: [email protected]