NHS Health Checks,The Tower Hamlets Story - a case study in the words of a facilitator
In early 2009, Tower Hamlets PCT decided to offer NHS Health Checks as a Locally Enhanced Service (LES) for all its residents over the age of 40 years who were not currently on the Coronary Heart Disease (CHD) or Diabetes register. To support this process the Clinical Effectiveness Group (CEG) produced localised evidence based clinical guidelines. The report was compiled by Dr. John Robson on behalf of the CEG, and has been endorsed by Tower Hamlets PCT. It was also agreed that QRISK2 Risk Scores would be the preferred method used to calculate risk as it was proven to be more efficient and equitable.
The CEG was commissioned to support the implementation process. This involved facilitators visiting each of the 37 practices in Tower Hamlets to:
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Identify the appropriate population using the search tools.
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Use the QRISK2 batch processing tool to generate a risk score for patients.
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Stratify the patients according to their risk scores.
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Provide training and support to the clinicians with regards to the use of the QRISK2 tool, computer templates and the call/recall system.
These tasks were successfully carried out in all of the practices in the first quarter of 2009. In total 53,700 patients were identified as eligible for an NHS Health Check, of which 50,600 have had a QRISK Score recorded in their medical records. 6,240 were identified in the high risk category and 44,455 were identified in the medium and low risk category. The QRISK calculator was also added onto the new patient check template. This allowed newly registering patients to have their risk assessed who were then opportunistically offered an NHS Health Check.
CEG was also commissioned to provide in-practice support and audit the service. This involved:
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In-practice facilitation in the use of the clinical guidelines, Clinical Computer templates and search tools.
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Collaborating with PCT management in identifying criteria to trigger payment and improving locality services to achieve local and national targets.
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To improve the quality of data and reporting, through the production of clinical computer templates and electronic audit tools and also provide training in their use to the local health sector.
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To feedback results of the CEG quarterly and annual audits to the practices and the PCT and ensure that practices participate in regular clinical audits.
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And analyse data and compile summary reports to meet PCT requirements for local and national targets.
CEG facilitators were heavily involved in getting the service off the ground. Training and support was provided to Health Care Assistants who are the first point of contact for patients. Periodic practice visits and a 9am to 5pm hotline were made available by the CEG for practices. MIQUEST and EMIS Web based audit tools were created by CEG to monitor and report on the performance of practices. These tools proved to be very helpful for practices in identifying eligible patients and monitoring their progress post an NHS Health Check. In total, 37% of the high risk population has had an NHS Health Check.
The programme is now in its second year and the NHS Health Check has become part of the CVD Care Package. This service is being offered via a practice network and enables the patient to access the support from any practice in the network. The care package jointly developed by Tower Hamlets PCT and CEG will be a comprehensive programme combining NHS Health Checks, treatment for hypertension and a secondary prevention programme for those diagnosed with CHD. CEG is in the process of developing clinical dash boards to support clinicians in improving the quality of patient care. It will continue to provide in practice facilitation support to improve and monitor the programme.
The Clinical Effectiveness Group |
