Government to consider a more personalised and 'intelligent' approach to NHS Health Checks
While the NHS’s new targeted health checks have been generally applauded, critics say NHS England needs to ensure changes are made based on evidence.
A government-led review of the NHS Health Check programme will look into providing patients with “personalised interventions” based on where they live, their age and their genetics.
By overhauling the programme, the government said it will move away from providing a ‘one-size-fits-all’ model and instead offer “an intelligent check” to help improve the prevention and treatment of disease.
But critics of the programme have said the government will have to provide further details before it is clear whether the new checks will lead to improved uptake of health checks and better outcomes for patients.
The NHS currently offers a standardised health check to everyone aged 40–74 years, intended to spot the early signs of major conditions that cause early death, such as stroke, kidney disease, heart disease and type 2 diabetes mellitus.
However, according to the latest NHS data, just 8% of eligible adults opted to have a health check in 2018/2019.
A review of the programme, announced in a government statement on 16 August 2019, aims to look into whether personalised, intelligent health checks that take age, risk factors and location into account “will be beneficial to preventing devastating diseases”.
As well as looking into “ways to increase the uptake of health checks”, the review will consider offering specific check-ups for people approaching retirement age “to help prevent or delay future care needs”. It will also look into offering online health checks for people who are at low risk of cardiovascular disease.
Following the announcement, Claire Anderson, chair of the English Pharmacy Board at the Royal Pharmaceutical Society (RPS), said it would be important for public health services to be “adequately funded” to continue providing the health check programme.
“We know that pharmacy can play a key role in personalised data-led health checks, including for conditions such as cardiovascular disease and type 2 diabetes,” she added.
The RPS previously called on the government to make health checks available through community pharmacies in 2018. When asked about the role community pharmacy would have in the new health check programme, the Department of Health and Social Care said the sector is well placed to support the implementation of the NHS Health Check.
Azeem Majeed, head of primary care and public health at Imperial College London — who has previously been critical of the efficacy of the health check programme — told The Pharmaceutical Journal that he is “in favour of a more targeted approach with the proviso that the new programme is based on good evidence of effectiveness”.
“Uptake of the programme in the early years was low and the clinical benefits thus far have been modest,” he said. “If the programme is to be modified, then NHS England needs to ensure any changes are based on good evidence and there is a clear plan for evaluation.”
He added that the government announcement lacks details. “It’s not clear how some parts of the new programme will work. We will need to await further details to see if this will lead to improved uptake of health checks and better outcomes for patients and the NHS,” he said.
Helen Stokes-Lampard, chair of the Royal College of GPs, said that the college had questioned the benefits of “blanket health checks”, so the move towards a more targeted approach was a “positive step forward”.
However, she said there were more issues to be explored in the review, such as the unintended consequences of whole genome DNA testing to see if a patient has a genetic disposition to certain conditions.
“We need to consider … the huge ethical and financial implications of suddenly knowing what health conditions you may be more susceptible to; and patients being worried about any health concerns that are identified but of dubious personal impact, or where nothing can be done to improve the prognosis.”
Matt Hancock, secretary of state for health and social care, said that personalised, preventative healthcare was “mission critical” to the future-fit healthcare service he wanted to build.
He added that the review will help “find data-led, evidenced based ways to support people to spot, manage and prevent risks to their health through targeted intervention”.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206960
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