title: Implementation of NHS Health Checks in general practice: variation in delivery between practices and practitioners.
abstract: Aim To evaluate NHS Health Check implementation in terms of frequency of data recording, advice provided, referrals to community-based lifestyle support services, statin prescribing and new diagnoses, and to assess variation in these aspects between practices and health professionals involved in delivery.
  
  
  
  Most NHS Health Checks are delivered by general practices, but little detail is known about the extent of variation in how they are delivered in different practices and by different health professionals.
  
  
  
  This was an observational study conducted in a purposively selected sample of 13 practices in Sefton, North West England. Practices used previously recorded information from their clinical management systems to identify patients with cardiovascular disease (CVD) risk ⩾20%, a potentially cost-effective approach. The evaluation was conducted during the first year of delivery in Sefton. Data were extracted from medical records of all patients identified, regardless of Health Check attendance. Findings Of the 2892 patients identified by the 13 practices, 1070 had received an NHS Health Check at the time of the study. Of these, only 936 (87.5%) had a recorded CVD risk score, with risk ⩾20% confirmed in 92.0%. Estimated risk category was correct in 456/677 (67.4%) of patients with estimated and actual risk scores. Significant variation was found between practices and health professionals in parameters recorded, tests requested, advice given and referrals for lifestyle support. Only 45.3% of patients had body mass index, smoking, alcohol, exercise, blood pressure and cholesterol all recorded. Lifestyle advice and referral into lifestyle services were documented in 80.6% and 6.4% of attenders, respectively, again with significant variation between practices and professionals. Statin prescribing rose in attenders from 19.6% to 34.6%. A similar proportion of attenders and non-attenders received new diagnoses.
  
  
  
  Effort is required to reduce variation in how practices deliver and follow-up NHS Health Checks, to ensure the consistency of the programme.
authors.affiliation: 1Professor of Clinical and Professional Pharmacy,Medway School of Pharmacy,Universities of Greenwich and Kent,Chatham Maritime,England.
authors.forename: Janet
authors.initials: J
authors.lastname: Krska
authors.affiliation: 2Public Health Development Manager,Sefton Council Public Health Department,England.
authors.forename: Ruth
authors.initials: R
authors.lastname: du Plessis
authors.affiliation: 3Deputy Director of Public Health,Sefton Council Public Health Department,England.
authors.forename: Hannah
authors.initials: H
authors.lastname: Chellaswamy
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000628:therapy*; D004739:England; D005260:Female; D058006:General Practice / Q000379:methods* / Q000706:statistics & numerical data*; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013222:State Medicine / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Health Checks; general practice; lifestyle; risk factors; variation