NHS Health Checks telephone outreach to more deprived and minority ethnic communities

A telephone outreach programme to encourage people from more deprived and minority ethnic communities to attend an NHS Health Check was well received by patients, NIHR CLAHRC West research has shown. The research also showed GP practice staff valued outreach workers’ specialised communication skills and highlighted how changes to the programme could make it more successful.

GP practices are the main provider of NHS Health Checks, usually inviting patients by letter. In Bristol, telephone outreach has been used to encourage people in more deprived communities and minority ethnic groups to attend NHS Health Checks, with community outreach workers based in GP practices phoning patients. Where possible, people were called by an outreach worker with a similar cultural background who spoke their language.

This study examined the views and experiences of both patients and staff of this telephone outreach approach. The researchers wanted to find out how the intervention was delivered by the outreach workers, how the patients found it and the impact it had.

The team interviewed 24 patients who were called about an NHS Health Check. They also interviewed the 10 outreach workers who made the calls and five GP practice staff who worked with them to deliver the service. The GP practices were all in more deprived areas.

The patients who were called liked getting a phone invitation to an NHS Health Check. They also liked being able to book an appointment during the call. They said it made them more likely to have an NHS Health Check than if they had only been sent a letter.

Being called by someone from a similar background who spoke their language was important for some people, and it would help if matching of outreach workers to patients was improved. Most of the patients didn’t mind answering questions about their lifestyle over the telephone, and some patients said that answering these questions and being directed to healthy lifestyle services had prompted them to make lifestyle changes.

GP practice staff thought the telephone outreach workers were good at talking to the people they called, and the outreach workers described having specialist knowledge of the target communities. Some outreach workers found asking the lifestyle questions over the telephone difficult and time-consuming, and said that these were often repeated during the NHS Health Check appointment. Some of the outreach workers were confident directing people to healthy lifestyle services, but others thought that they needed more training.

The outreach workers and GP practice staff interviewed saw telephone outreach as a good way to engage patients in NHS Health Checks. It could also reduce the administration GP practices needed to do to invite patients to NHS Health Checks.

Some GP practice staff mentioned difficulties with fitting appointments for NHS Health Checks into their already busy schedules. Some staff weren’t clear about the aims of the telephone outreach service, meaning they might not have made full use of telephone outreach workers’ specialist skills. For example, the patient wouldn’t benefit from the outreach worker’s interpreting skills or local community knowledge if they didn’t have a similar cultural background.

Tracey Stone, from University of Bristol and NIHR CLAHRC West and a lead author of the study, said:

“Our research showed that this telephone outreach approach was popular with patients. It worked particularly well when the outreach workers were well-matched to the people they were calling. Practice staff particularly valued the community outreach workers’ skills in communicating with patients.

“For telephone outreach to reach its full potential, it’s vital that there are clear objectives for recruiting and training outreach workers, along with support to set up and embed the service in GP practices.”

NHS Health Checks were introduced in 2009 to provide a health check-up for adults in England aged 40-74. They’re designed to spot early signs of stroke, kidney disease, heart disease, diabetes and dementia. They also provide people with support to help reduce their risk of developing these diseases, including help with stopping smoking, maintaining a healthy weight, being active and access to medical treatment for high-risk patients.

These diseases are more common in more deprived communities and some minority ethnic groups and this contributes to health inequalities. However, criticism of the programme includes that it attracts the ‘worried well’, and that those who could benefit most from the programme are least likely to attend an NHS Health Check.

Papers

Patient experiences of telephone outreach to enhance uptake of NHS Health Checks in more deprived communities and minority ethnic groups: a qualitative interview study
Emer Brangan, Tracey Stone, Amanda Chappell, Viv Harrison, Jeremy Horwood (2018) Health Expectations, December, 1-9

Telephone outreach by community workers to improve uptake of NHS Health Checks in more deprived localities and minority ethnic groups: a qualitative investigation of implementation
Tracey Stone, Emer Brangan, Amanda Chappell, Viv Harrison, Jeremy Horwood, (2019) Journal of Public Health, fdz063