1. NHS Health Check Training Lauren Seamons – Norfolk LPC October/November 2015

2. What is an NHS Health Check?

3. Cardiovascular Risk

5. What is an NHS Health Check? Norfolk Fire and rescue service video Norfolk County Council Health Check Video Why have an NHS Health Check? Video

6. Can I offer NHS Health Checks? Consultation room Clinical Waste disposal Equipment - CardioChek or LDX - Scales (Class 3) - Height Chart - Tape measure - BP Monitor (BHS approved) Staff (www.bhsoc.org/bp-monitors/bp-monitors)www.bhsoc.org/bp-monitors/bp-monitors IT availability Contract SOP

7. Recruiting patients NHS Health Checks Counter Staff Letter from GP Links to/from other services Eligibility Do you have a booking system?

8. Eligibility Patient MUST: be aged 40-74 years old reside and/or registered in Norfolk Patient must not have been diagnosed with: Coronary heart diseaseChronic kidney disease (CKD) DiabetesHypertension Atrial fibrillationTrans ischaemic attack (TIA) HypercholesterolaemiaHeart failure Peripheral diseaseStroke or be taking a statin Patients may access the service ONCE every 5 years

9. Eligibility Available from the Health Information Leaflet Service now accessible via the Norfolk’s Living Well website

10. Performing an NHS Health Check Explain what will happen Patient Details Consent Height Weight and BMI calculation Blood pressure Diabetic RiskRisk Score Cholesterol measurement Lifestyle

11. Blood Pressure Use correct cuff size Advise patient to sit comfortably with feet flat on the floor (no crossed legs) Breathe normally Keep arm relaxed Repeat if >140/90 Repeat a third time towards the end of the check if still >140/90

12. Body Mass Index Calculator on PharmOutcomes Alternative template for discussion

13. Waist Measurement (optional) BMI classificationWaist circumference LowHighVery high Overweight (25-29.9)No increased riskIncreased riskHigh risk Obesity 1 (30 – 34.9)Increased riskHigh riskVery high risk Men: Low = less than 94cm, High = 94-102cm, Very high = more than 102cm Women: Low – less than 80cm, High = 80 – 88cm, Very high = more than 88cm For individuals with a BMI between 25 - 35 Measure from the side The tape measure should be snug but not indent the skin.

14. Physical Activity Calculator on PharmOutcomes Alternative template for discussion

15. AUDIT -C http://www.alcohollearningcentre.org.uk/eLearning/IBA/platforms/ALC/ http://www.alcohollearningcentre.org.uk/eLearning/IBA/platforms/ALC/ then click Pharmacy E-Learning 0 – 7 Lower risk 8 – 15 Increasing risk 16 – 19 Higher risk 20+ Possible dependence

16. Dementia http://www.healthcheck.nhs.uk/increasing-dementia-awareness-training-resource/

17. Communicating Risk Who will communicate the risk score? Be clear when a GP referral is necessary Encourage the patient to choose their own changes Get the balance right

18. Support Materials Health Information Leaflet Service

19. Making Referrals Reason for appointment ThresholdActionTime High CVD risk≥ 20%Referral to practice nurse or GP for cardiovascular risk assessment Within 2 weeks Blood pressure140 to 159 systolic and / or 90 to 110 diastolic Referral to practice nurse or GP for Hypertension risk assessment and Chronic kidney disease risk assessment. Within 2 weeks 160 to 179 systolic and / or > 110 diastolic Within 1 week ≥ 180 systolicUrgent referral to GP for Hypertension risk assessment, Chronic kidney disease risk assessment and other CVD risk management. Same Day FPG≥ 7mmol/lRepeat FPG, intensive lifestyle advice or Referral to practice nurse or GP for diabetes risk management. Within 1 week HbA1c≥ 6.5%/48mmol/lRepeat HbA1c, intensive lifestyle advice and Referral to practice nurse or GP for diabetes risk management. Within 1 week Total cholesterol> 7.5 mmol/lReferral to practice nurse or GP to assess possible familial hypercholesterolemia Within 2 weeks Weight management BMI ≥ 35Referral to practice nurse or GP for weight management. Within 2 weeks

20. Making Referrals