More must be done to ensure men, and younger patients in and around Bristol attend routine NHS Health Checks, according to a new study from the universities of Bath and Bristol.
By analysing patient data across 38 GP areas for the City from 2010 - 14, the researchers from Bristol’s Centre for Academic Primary Care with the Department for Health at the University of Bath, found that women were more likely to attend for their NHS Health Check compared to men, as were those who were older compared to younger patients.
Disparities in attendance
NHS Health Checks can play an important role in reducing health inequalities. Researchers found that despite slightly more men compared to women being invited for their NHS Health Check, significantly more women attended compared to men (53 per cent versus 47 per cent) They also found that over 60s were up to twice as likely to attend compared to those in their 40s and 50s. However, they found no statistically significant evidence of inequity in attendance.
With a primary purpose of reducing incidence of cardiovascular disease (CVD) and health inequalities, routine NHS Health Checks are designed to help tackle a growing public health challenge. CVD is one of the leading causes of premature morbidity in the UK, already estimated to cost the UK £15 billion a year but likely to rise to £18 billion by 2020. Smoking, being overweight, drinking more than 14 units of alcohol and being physically inactive, are all considered key risk factors for CVD incidence.
These latest findings suggest that people with a high risk of heart attack or stroke were more likely to be prescribed a cardiovascular drug and referred to a behavioural lifestyle service such as smoking cessation, exercise or weight management. Those patients referred to behavioural lifestyle management courses were more likely to be living in the most deprived areas.
First introduced in 2009 as part of the government’s commitment to tackle avoidable deaths, disability and to reduce health inequalities, NHS Health Checks are intended to act as an early prevention to address health inequalities. Through a combination of techniques they assess patients aged 40 – 74 for a range conditions including Type II diabetes, stroke, heart and chronic kidney disease alerting patients to lifestyle changes that might be required.
In order to combat some of the challenges identified in attendance, the research suggest a range of methods – including introducing more flexible appointments and bringing NHS Health Checks into the workplace – to better target the intervention. A number of these recommendations are already being considered by local partners in Bristol.
Important messages for policy-makers
Lead author, Dr Nikki Coghill from our Department for Health explained: “Given the significance of growing incidence rates for cardiovascular disease in the UK, the findings of our study presents an important message for policy-makers keen to ensure the benefits of NHS Health Checks reach all communities.
“Inequalities in health mean that those who live in areas of deprivation are generally at higher risk of ill health, and we know that men tend to have higher risk of coronary heart disease too. These factors combined with the fact that we now know these groups are less likely to take up this free NHS service, means we need to re-think how we target these interventions. This might mean offering appointments at varied times to better suit working lives, or even offering NHS Health Checks in work places.
“We also need to address the age disparity we see with older people much more likely to attend check-ups. If we can encourage those at the lower end of the age range to attend, we stand a much better chance of picking up risk factors earlier, before they have started to impact an individual’s long-term health.”
Additional recommendations from the researchers include more standardised approaches to recording ethnicity data as part of the NHS Health Check process.
For this study the researchers noted that ethnicity was often poorly recorded by GP practices. This made it difficult to determine whether BAME groups were accessing NHS Health Checks on an equal basis with non-BAME groups.