Evaluating telephone outreach for NHS Health Checks to improve uptake in more deprived communities

Cardiovascular disease (CVD), which is a general term for a disease of the heart or blood vessels, is a major cause of early death, ill-health and disability in the UK. The burden of this type of disease falls more heavily on people living in deprived circumstances and people from black and minority ethnic (BME) communities.

In 2009 the NHS introduced its NHS Health Check programme. The programme aims to identify and prevent cardiovascular risk by providing routine structured clinical assessment, and management, for adults aged 40–74 years without pre-existing diabetes or cardiovascular disease. The NHS Health Check includes a review of an individual’s risk of cardiovascular disease, support to change their behaviour, such as smoking, diet, exercise and alcohol consumption, and treatment of any risks that are identified or other diseases.

NHS Health Checks tend to take place at GP practices, and they generally invite patients by letter. The checks are part of a wider strategy to improve the health and wellbeing of the nation, and reduce health inequalities.

Evidence suggests that those who are most at risk, and potentially with most to benefit from NHS Health Checks, may be least likely to attend one. Uptake of NHS Health Checks may be lowest among lower socioeconomic groups, men and BME communities, and this could potentially make health inequalities worse.

Community based programmes can increase uptake of preventive health initiatives like the NHS Health Checks, evidence suggests. These programmes use existing assets in a community, such as community networks. Trusted and respected community members can play an important role in publicising and facilitating attendance at NHS Health Checks.

Bristol Public Health has developed a telephone outreach initiative to encourage uptake of NHS Health Checks among communities where risk of cardiovascular disease is higher, and where patients are less likely to respond to an invitation to attend. The telephone outreach service in Bristol’s in more deprived areas is a partnership between voluntary and community sector organisations and GP practices. This involves community outreach workers, or interpreters working in GP practices, phoning patients to engage them with the NHS Health Checks programme.

The Ethnography team at NIHR CLAHRC West, led by Dr Jeremy Horwood, is doing ‘qualitative’ research – including interviews and other ways of understanding people’s opinions – to explore the effectiveness of telephone outreach for NHS Health Checks. They will do this through understanding the experiences, attitudes and views of patients, the community workers delivering the service and the GP practices hosting them.

What they find will inform the initiative to improve the uptake and effectiveness of NHS Health Checks in communities with greater health needs. Improving uptake may lead to more people being motivated to make lifestyle changes to reduce their risk of long term conditions, and accessing support to help them do so, thus helping to reduce the health inequalities associated with these conditions. We also anticipate that the research will improve understanding of the potential for telephone outreach in other public health interventions.