+ NHS Health Check Programme Priscilla Wong GPST2

+ Objectives What is the NHS Health Programme? What are the benefits of having such a programme? What is involved?

+ Background Local authorities responsible for provision of NHS Health Check Programme Mandatory requirement Public health programme Local authorities can decide where health checks take place depending on needs of each area e.g. pharmacy, GP surgery. Aim for take up rate >75%

+ Preventative programme intended to help people stay healthy for longer Risk management through provision of lifestyle interventions is not a legal responsibility of local authorities

+ Aims of the programme To prevent/ delay onset of diabetes, heart, kidney disease and stroke Reduce levels of alcohol related harm Raise awareness of the signs of dementia Narrow health inequalities 2 parts- risk assessment and risk management

+ Why is it needed? Early detection individuals with increase cardiovascular risk is estimated to prevent up to 1600 non-fatal heart attacks and strokes An estimated 20,000 cases of diabetes or kidney disease are identified earlier = early intervention Lack of RCT evidence supporting NHS Health Checks Addresses lifestyle factors increasing risk of diseases

+ Eligibility criteria People aged 40 to 74 Every five years No other chronic conditions e.g. CHD, CKD, diabetes, HTN, AF, TIA, hypercholesterolaemia, heart failure, PAD, stroke. Not taking a statin Cardiovascular risk less than 20% over the next 10 years from previous checks.

+ What is involved? Age Gender Smoking status FH- CHD Ethnicity BMI- >=27.5 in Indian, Pakistan, Bangladeshi, Asian or Chinese require random glucose, >= 30 if other ethnicity Cholesterol level

+ BP- >= 140/90, fasting glucose or HbA1c needed, HTN assessment and assessment of CKD. Physical activity level- GPPAQ, ?exercise referral Cardiovascular risk- QRISK 2 Alcohol consumption- AUDIT-C score >5, needs full AUDIT

+ Raising awareness of dementia Age Prevalence 800,000 in UK and increasing Awareness of symptoms/signs of dementia Referral to memory clinic if appropriate

+ References NHS Health Check Website: are_professionals/ are_professionals/ NHS Health Check Best Practice Guidance Oct 2013 Public Health England Press Release NHS Health Check: Our approach to the evidence July 2013

+ Scenario 1 32 year old female, normally fit and well comes to see you during your morning surgery. She wants a general health “MOT”. How would you approach this situation?

+ Scenario 1 continued She’s been feeling quite tired recently despite sleeping the same hours. Friend from work has just been diagnosed with hypothyroidism and had similar symptoms. Concerned she may also have the condition

+ Scenario 2 36 year old male Smoker- 15/day Otherwise fit and well Recently watched a bbc 2 programme about diet- fat vs sugar Would like a general check up for “everything”

+ Scenario 2 continued Concerned re: his own diet and weight. Doesn’t do much exercise and his parents both had ischaemic heart disease Weighs 105 kg Height 1.80m BMI 32.4