NHS Health Checks in the community pharmacy : a profile of the Islington experience Chrystal Greenwood Project Officer, NHS Health Checks and Long Term Conditions

2 OVERVIEW OF NHS HEALTH CHECKS PROGRAMME IN ISLINGTON

3 Phased implementation until 31 st March 2012, across 3 delivery settings: Implementation of the NHS Health Checks Programme in Islington: progress so far General Practice 2009/10 Target risk group: QRisk2 > 20% 3,900 HCs delivered 2010/11 Target risk group: QRisk2 > 15% 3,992 HCs delivered 2011/12 (plans) Target risk group : QRisk2 > 10% 7,000 HCs to be offered 4,900 HCs to be delivered 2012/13 Full roll out expected  Approximately 70,000 eligible pop  14,000 checks to be offered every year  10,500 checks to be delivered (70% uptake of offered) Community Pharmacies 2009/10 Pilot programme to test feasibility 2010/11 Target risk group:any 721 HCs delivered 2011/12 Target risk group: any 1,500 HCs to be delivered Community Outreach 2009/10 n/a 2010/11 Target risk group: any 1,742 HCs delivered 2011/12 Target risk group: any 2,000 HCs to be delivered

4 Who is our population?

5 Aim of Community Pharmacy programme  Deliver a minimum of 2,000 NHS Health Checks across 10 Community Pharmacies  200 per pharmacy per year = 50 per quarter (17 per week).  Prioritise delivery to Islington residents who are not registered with a GP, or who are registered and do not access primary health care on a regular basis  Expression of interest process open to all community pharmacies

6  Aligned to national guidance  NHS Health Checks Steering Group includes clinical input Patient pathway

7 Software provider

8 Training 1) Delivering the NHS Health Check One day course delivered by CVD team at the Royal Free Hospital Designed to provide health professionals with an update on aspects of the NHS Health Check in line with the most recent evidence and current national guidelines. Objectives:  the knowledge to carry out the NHS Health Check  knowledge on quality assurance in near patient testing.  knowledge on interpretation of the biochemical measurements in the NHS Health Check 2) Supporting Behaviour Change training One day course delivered by Whittington Health

9 WEQAS  External quality assurance scheme.  Pharmacy sent samples on a bi-monthly basis to test within the specified timeframe.  Commissioner uploads the results to determine any tests which fall outside of the acceptable range  Second sample is sent to pharmacies with an unacceptable result to identify any ongoing issue with equipment  Results are analysed and sent to Consultant Biochemist to review

10 WHO DID WE REACH IN THE PHARMACY?

11 HCs in community pharmacy by sex and age The majority of pharmacy HCs were in persons aged under 55 (78%), with a similar proportion aged 35 to 44 as 45 to 54. This pattern was similar for men and women and is similar to the age distribution of health checks in community settings.

12 HCs in community pharmacy by registration status There were 721 HCs carried out in pharmacies, against an original target of 1,500. Six percent of persons who had Health Checks in pharmacies were unsure of whether they were registered with a GP practice (n=40). There were more pharmacy Health Checks in women than in men (64%, n=465 versus 36%, n=256), mirroring the gender profile of health checks in community outreach settings. Seven percent of men (n=19) said they were unsure of whether they were registered with a GP practice whereas the equivalent percentage was 5% for women (n=21). Overall 6% of health checks in pharmacies were in unregistered patients or patients who were unsure if they were registered.

13 Ethnicity

14 Clinical results

15 HCs in community pharmacy by QRisk2 score Four-fifths of persons (n=581) having HCs in pharmacies were found to have a low QRisk2 score (QRisk2 <10%). Six percent (n=41) of persons had a QRisk2 score of >20%. This distribution of CVD risk identified via HCs in pharmacies is very similar to the distribution in HCs carried out in the community outreach programme.

16 Lifestyle information

17 PROGRESS TOWARDS TARGETS

18 Performance by month

19 Support  NHS Health Check branded posters for display in pharmacy  Incentive scheme for pharmacy assistants – ‘whole- pharmacy’ approach  Branded NHS Health Check Prescription bags sent out to pharmacies to use when dispending medication (not always easy when people have pre-existing diagnosis)  Monthly feedback

20 Pharmacist perspective “The NHS Health Check has worked really well, as both myself and team members believe that we can contribute to a reduction in the number of medicines given out for blood pressure and cholesterol by actually detecting it [disease] early and instructing the individual to improve their lifestyle….in addition it actually boosts the reputation of the pharmacy and portrays an image of a "caring and friendly team taking steps to help the community". “The reason for our success is the continued and active training of staff members to always be on the lookout for anyone who is eligible to undertake a health check. We will continue to carry out this additional service, as the positive impact that it has on the community is something which we witness every day."

21 Outcomes from NHS Health Checks (All HCs in Islington, 1 st April 2010 – 30 th March 2011, all settings) 21

This analysis is based on all HCs conducted in Islington in 2010/11, irrespective of setting. However, for a proportion of health checks undertaken in community settings, where these have not been entered in GP systems, it is not possible to follow up the outcomes of these HCs ie identify new diagnoses made as a result of the HC. A total of 250 new diagnoses for hypertension, PVD, heart disease, stroke/TIA, atrial fibrillation, diabetes, chronic kidney disease, and hypercholesterolaemia following Health Checks in Islington were made. Hypertension accounted for the largest number of new diagnoses (n=133), followed by diabetes and hypercholesterolaemia (n=46 and n=45 respectively). New diagnoses are defined as those following the HC, but no time limit is specified between the HC and the new diagnosis. Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74, Islington registered population. New diagnoses following HCs

% of new diagnoses were in men (n=161) and 36% in women (n=89) Slightly more than 30% of new diagnoses were in persons in each of the age groups 55 to 64 (32%) and 65 to 74 (30%). The largest number of new diagnoses in men was in the age group 55 to 64 (35%). In contrast, for women the largest numbers were in the age groups 45 to 54 and 65 to 74 (both 32%). Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74, Islington registered population. 23 New diagnoses by sex and age

24 Forty-four percent of persons given one or more new diagnoses following Health Checks had a QRisk2 score of 20% or more (n=105). However, it is worth noting that more than a fifth had a low QRisk2 score (<10%) (22%, n=53). This pattern differed for men and women. More than half of men given a new diagnosis had a QRisk2 score of 20% or more (51%, n=76). For women the equivalent figure was 33% (n=29). In contrast, 36% of women given a new diagnosis had a low QRisk2 score (<10%) (n=31), whereas it was only 15% for men (n=22). Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74, Islington registered population. 24 New diagnoses by QRisk2 category

Where to from here?  Targeted small-scale campaign planned for January 2011  Pharmacy visits during Q3, 2011/12  Further evaluation to compare NHS Health Checks in community pharmacy to other settings.

26 Thank you. Contact details: Chrystal Greenwood Project Officer, Long Term Conditions

27 Number of Health Checks by setting, sex and QRisk2 score In GP practices, 58% of checks were in men and 42% on women. However, in community and pharmacy settings, around 60% of checks were in women and 40% in men. 41% of checks in GP practices were in persons with a low QRisk score, compared to 80% in community and pharmacy settings. 20% of checks in GP practices were in persons with QRisk2 of 20%, compared to 6% in pharmacy and community settings.