1. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk EVALUATION OF NHS HEALTH CHECKS PROGRAMME IN CAMBRIDGESHIRE (November 2009 to March 2010) Janet Watkinson NHS Health checks programme lead

2. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Cambridgeshire at a glance Cambridgeshire population 610,000 (2010) Percentage of population within 40-74 years 41% 1% of population in Cambridgeshire lives within 20% most deprived areas of England (2007) Health inequalities exist in Cambridgeshire. There is a 5 year difference in life expectancy for males between least and most deprived areas in the county.

3. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Population distribution by deprivation quintiles

4. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk The programme DH recommended implementation of NHS Health checks programme for people aged 40- 74 years from 2009/10 Selection criteria applied Early identification of people with high risk of developing cardiovascular disease By taking a history, examination and a simple blood test

5. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk NHS Cambridgeshire programme There was no existing systematic cardiovascular risk detection programme A completely new initiative for the PCT The initial implementation was through GP practices With intention of broadening the range of providers i.e community pharmacies

6. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Local target 12,000 health checks from April 2009 to March 2010 Involvement of 8 GP practices to deliver the programme Learning lessons from the initial phase and then roll out into a wider programme of call/recall health check and referral/intervention from 2010/11

7. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Objective To identify any areas that needs to be improved for future implementation Identify areas of good practice To give the service provider an opportunity to give a useful feedback on programme delivery

8. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Methods All 8 practices participated in delivering NHS health checks in Cambridgeshire were engaged in evaluation Questionnaire was used to gather both qualitative and quantitative information (Questionnaire was designed with the input of GP lead and NHS health checks steering group members) Questionnaire completed by each practice and returned by end of April 2010

9. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Methods contd., Qualitative information: Experience of those delivering the programme, feedback on service delivery, patient perception and suggestions for improvement. Quantitative data: Number invited, demographic profile, number of people with newly detected risk factors, number of high risk people and number of non attendees

10. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Results Response rate: –Qualitative part 87.5% (7/8) –Quantitative part 100% (8/8)

11. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Overall programme implementation 6/7 practices: very good or satisfactory implementation Reasons: –Good IT system –Help from the local PCT –Proper organisation and planning –Working with local resources and people (e.g Traveller groups, Bangadeshi population)

12. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Risk assessment of the patients Problems identified –Difficulty in motivating well and hard to reach people (3/7) –Lack of near patient testing (3/7) Solutions –Open days to encourage people (1/7) –Discussions with local trust regarding near patient testing (2/7) –Employing extra nursing time (3/7) –Interpreter service for Bangladeshi population (2/7)

13. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Risk management of patients Problems –Lack of consultation time (3/7) –Language barrier (2/7) –Lack of near patient testing resulted in loss to follow up (3/7) Solutions –Late run surgeries (2/7) –Development of leaflets in different languages (2/7) –Use of recall system to prevent people from loss to follow up (1/7)

14. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Suggestions to improve service delivery Availability of near patient testing Flexible service provision Pre defined outcome measures and data required for monitoring and evaluation Increasing the level of communication to the public Organising a clear patient pathway within the practice

15. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Key learning points Consider the role of near patient testing Be open minded (think out side the box) about how to reach the target group –Use of existing and established systems to approach hard to reach –New innovative approaches (open evenings) –Local publicity Establish local systems to avid loss to follow up Evaluation and data collection should be upfront

16. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Outcomes achieved Total number of health checks completed between 1 st November 2009 to 31 st March 2010 was 2403 Target for the study period 2180 Coverage 110%

17. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Number of patients seen against the target by practice

18. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Percentage of risk factor detection (n=2403) Risk factorNumberPercentage At least one risk factor 99441.4 Hypertension35314.7 Obesity62626.1 Diabetes110.5 Kidney disease40.2

19. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Percentage of people detected with hypertension and obesity by practice

20. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Percentage of people with 20% CVD risk within next 10 years by practice Percentage Percentage

21. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Demographic profile of high risk patients 51.6% were between 60-69 years of age 81% were male 84.7% White British

22. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Risk factor management Out of all the health checks completed –230 (9.7%) referred for smoking cessation –156 (6.6%) referred to exercise referral schemes –2250 (94.9%) given life style advice –140 (5.9%) were put on medication –23 (1%) referred for further testing

23. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Number and percentage of eligible people who did not attend the health checks PracticeNumber invitedNo did not attend 112754 (42.5) 26387(1%) 33733(0.8%) 4327206 (63%) 7164101 (62%) 818520 (10.8) Total1776384 (22%)

24. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Demographic profile of DNAs Just under a half (48.6%) of DNAs were young between 40-49 years of age. In the 60-69 age group, the age group with highest CVD risk, 27% did not turn up for their health check. 57% of those who did not attend were male and 80% were White British

25. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Recommendations Provision of near patient testing to minimise loss to follow up Good communication and awareness raising of the target population using media and PCT communication system. Use existing systems and developing innovative methods to encourage hard to reach population, young people and working population. This could be achieved using nurse led afternoon clinics, week-end clinics or clinics at the work places.

26. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Recommendations contd., Annual evaluation of the programme to identify strengths and weaknesses of the programme. The method of evaluation and type of data to be collected must be agreed with the programme implementers at the beginning of the implementation Continuous learning from the programme implementation

27. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk So What……………..? Sharing evaluation findings –Published as a case study in the web –National networking workshop Availability of near patient testing Sharing good practice through workshops and training days Including evaluation as part of the programme Principally targeting 20% most deprived practices

28. NHS Cambridgeshire (formerly Cambridgeshire PCT) Visit our web site: www.cambridgeshire.nhs.ukwww.cambridgeshire.nhs.uk Acknowledgements Dr Gina Radford, Chair NHS Health Checks steering group All GP practices delivered the NHS health checks programme in Cambridgeshire and responded to this evaluation. NHS Cambridgeshire Health Checks Steering Group members.