Evaluation of a national cardiovascular disease risk assessment programme (NHS Health Check): the perception of front-line primary care professionals in England

Background: The National Health Service (NHS) Health Check is a CVD risk assessment and management programme in England. Its aim is to improve CVD risk awareness in the population for those with CVD risk. Whilst most in primary care accept that the prevention programme benefits patients, a wide variation in uptake and delivery across England remains. There is a paucity of research on the effectiveness of the Health Check and even fewer evidence-based studies to assess the perception of front-line professionals delivering the programme. Aim: The aim of this thesis was to evaluate the effectiveness of NHS Health Check-related outcome measures as well as examining the perspectives of front-line professionals delivering the programme in primary care. Methods: Mixed-methods were used; quantitative data in the form of a systematic review of the literature and national survey; and thematic synthesis of qualitative data from clinically targeted focus group interviews in primary care. Medical and social science electronic databases were searched looking for national, regional and local studies from GP practices modelled on evaluations of England’s NHS Health Check (HC) programme. Crosssectional and cohort studies were included. The systematic review has been successfully registered in the NIHR PROSPERO Registry. To determine health care professionals’ views on the effectiveness of the NHS Health Check an original 29-item survey was developed based on the Theory of Planned Behaviour and on a review of relevant literature. After review by an expert panel, five questions were omitted, and one question was added. The resulting 25-item survey with satisfactory content validity and face validity was tested on six health professionals versed in primary care practice and familiar with the NHS Health Check. Focus groups with a purposive sample of front-line primary care professionals (GPs, Practice Nurse, HCAs) were interviewed (n=14). Key findings: Systematic review results reveal differences in content, process and delivery of the NHS Health Check across England. Equitable uptake is a concern. Very little data on behaviour change or referrals to lifestyle services is even recorded and/or inconsistent. Methodological and clinical heterogeneity makes generalisation of review results a 8 challenge. Controlling for educational differences, the professional perspectives on programme effectiveness were also contrasting. Most accepted that the Health Check benefitted patients. However, survey results indicate a significant difference (p=.00031) between professions and programme value-for-money; equally, strong evidence emerged (p=.0046) to suggest that profession (level attained) was associated with programme impact on population health. How cardiovascular risk is communicated is questioned. Doubts about evidence-based practice are also a concern. Focus group thematic synthesis identified six themes: overall programme impact, method of invitation, the consultation and patient experience, practice referral methods and who benefits (which demographic population) from attending a Health Check Conclusion: Elements of my thesis research identified variable degrees of programme delivery across England and varying degrees of opinion across professions. Looking forward, the NHS Health Check needs a standardised primary care model to optimise patient outcomes in cardiovascular disease. Much more measurable and evidence-based research is needed to support health policy and good practice.Open Acces