NHS Health Checks - a case study
in the words of a facilitator

NHS Health Checks - Supporting Practices and the PCT.

NHS Peterborough experiences higher mortality rates from Cardiovascular Disease (CVD) than nationally or compared to its ONS Cluster. NHS Peterborough began its roll out of the NHS Health Checks in January 2009.

Initially, there were two projects running alongside each other; eight practices with the highest Coronary Heart Disease (CHD) burden ran a pilot project and were given access to greater resources from both the PCT and CHD Nurse Specialist Team. At the same time all the other practices were signed up to offer NHS Health Checks to their patients. One particular flagship practice worked closely with the PCT to take this work forward.

Support for Recording and Reporting

EMIS practices were using Oberoi software to proactively target eligible patients and prioritise by CVD risk. However, Oberoi is not compatible with TPP practices so the PRIMIS+ Facilitator Team at NHS Peterborough took over the task to produce a standard method of targeting patients based on national guidance and using system searches and breakdowns.

The NHS Health Check must follow strict criteria which at its most basic must include:

• Identification of eligibility by estimated risk;

• Assessment of further risk factors;

• Management of risk ie. Advice/signposting/referral (as appropriate);

• Recording of patients’ final predicted risk and communication back to the patient;

• Diagnosis (where appropriate) and entry onto care pathway, or

• Exit from the NHS Health Check (with one year high risk / five year recall).

The facilitators had considerable involvement in supporting practices with interpreting guidance and recording the necessary data, including producing templates, recording and reporting documents and attending practice clinical meetings.

As part of the contract for this project, clinicians must have ensured the complete process above had been followed before coding a patient to ‘CVD risk assessment done’, which is what practices reported to the PCT in order to request a payment.

It also became apparent by working with practice nurses that the Health Check could be offered to eligible patients as part of a ‘new patient check’ consultation. Processes were therefore established to ensure this cohort of patients could also be captured.

At the end of the pilot, templates were amended to reflect additional requirements as well as those no longer necessary. The templates were presented to our Clinical Records Governance Group where they were approved for use and sent out to all practices.

As a result of the hard work done by everyone involved, NHS Peterborough has screened 800 patients in the eight pilot practices and 3,337 patients in total, the highest percentage of the target cohort in East of England.

Data validation

The Facilitator Team is now currently working with three practices with high NHS Health Check activity to complete a data validation audit. The process involves a selection of practices who achieved higher than 200% of their target for NHS Health Checks in 2009/10.

The initial part of the validation process is to check the activity submitted to the PCT against that reported on the clinical system. This was done by running a system search, based on the claimable Read code. The date range applied to the validation check should be one quarter, in order for the results to be referenced back to the complete submission made to the PCT.

As more than one clinician may have carried out an NHS Health Check in any particular practice, it was important to identify a number of patients who have had an NHS Health Check completed by each individual member of staff, and to use these as the sample from which to audit.

Each area outlined in the NHS Health Check process criteria should be easily identified by use of the standard coding, which would be evident within a patient’s record.

A validation exercise can therefore be undertaken by matching a selection of Read codes to a given number of patients who have had a CVD NHS Health Check recorded on their record.  This allows you to check for evidence of each stage of the NHS Health Check process, confirming it has been carried out.

The results of our initial data audit will be fed back to the Contracting and CVD Teams at the PCT. After this, lessons learned and good practice will be identified and shared as appropriate.

Zoe Angeloni