Weekly data exports from GP systems into CDR-Intell (for GPs who wish to use this software) Practice identifies target population for 2009/10 LES (55,000 over 5 years) Practice systematically invite their priority list for a screen offering choice of services for the screen (pharmacists / GP / community) Estimated can afford to invite 4286 in 2009/10 (10% of popn) Process of invitation is 1 letter, 2 follow-up phone calls and 1 last letter (case studies show this is best practice). See proposed letter and DoH info leaflet (freely available) Assumed take-up 50% (2143) Person goes to GP practice holding check Person goes to Community Pharmacist / community venue for the check HCA brings up CVD risk scoring template for completion (some are embedded in PAS) Use of electronic risk scoring template provided within the LES Screen consists of – (15 mins) Age Gender Smoking status Physical activity Family History Ethnicity BMI Cholesterol (venus bloods taken) Blood pressure Diabetes Risk – if high then take random blood glucose Local measures added - Alcohol consumption Waist circumfrence Screen consists of – (15 mins) Age Gender Smoking status Physical activity Family History Ethnicity BMI Cholesterol (near patient testing) Blood pressure Diabetes Risk – if high then take random blood glucose Local measures added – Alcohol consumption Waist circumfrence NB: Additional elements to the screen if use QRISK2 Patient books appt at GP Practice (assumed 1071 patients 09/10) Community provider calls named person in GP practice to let them know appt has been booked with them (assumed 1071 patients screened in pharmacies 09/10) INITIAL IDENTIFICATION AND INVITATIONSLES = £3 per person invited HEALTH SCREENLES = £11/screen (£18/screen for NPT Cholesterol) Proposed Swindon Health Check Pathway June 2009

Appropriately trained HCP communicates the risk (for GP practices this is a provisional risk pending Cholesterol results) HCA attaches screening results to patient record through template / read codes Pharmacists print template for results – posted to GP practices to be input via Docman where possible Appropriate lifestyle advice provided during 1-stop appt (15 mins), may be different person than person doing the tests. Advice based around ‘Swindon lifestyle advice booklet’ (being developed). Patient encouraged to contact services direct, for those who need additional support refer to Health Ambassadors. Referral onto appropriate lifestyle services. Note to patient that GP may request appt if concerned with any aspect of final results (assumed 2143 patients will receive lifestyle advice) If risk high (>=20%) Person either managed through appropriate disease register &/or seen for further testing / prescribing HEALTH SCREEN – CONTINUED GP writes to all patients with final results, noting re-call period. FINAL RESULTS FROM GPLES = £4patient As necessary self-referral to: Stop Smoking Services (4.5%, 141) Weight Watchers (16.7%, 525) SBC Leisure Services (37%, 1163) SWADS (Alcohol Service) (2.5%, 79) Health Ambassadors to support access to the above Numbers in brackets are national estimates of screened population who will take-up intervention and estimated local demand for 2009/10. SWADS uses local estimate for take-up. All other patients re- called in 5 years