Item Number: 264. PRIMARY CARE CO · PDF fileNHS Airedale, Wharfedale and Craven CCG AWC NHS...

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Page 1 Our Vision to Improve the Health & Wellbeing of our Communities Item Number: 264. PRIMARY CARE CO-COMMISSIONING COMMITTEE MEETING Meeting Date: 20/12/17 Report’s Sponsoring Governing Body Member: Clare Beard, Public Health Consultant Report Author: Jenny Loggie, Health Improvement Manager, Natalie Smith, Health Improvement Officer 1. Title of Paper North Yorkshire NHS Health Checks Annual Report 2016-17 2. Strategic Objectives supported by this paper: (check those which apply) To create a viable & sustainable organisation, whilst facilitating the development of a different, more innovative culture To commission high quality services which will improve the health & wellbeing of the people in Scarborough & Ryedale To build strong effective relationships with all stakeholders and deliver through effectively engaging with our partners To support people within the local community by enabling a system of choice & integrated care To deliver against all national & local priorities incl QIPP and work within our financial resources 3. Executive Summary: From April 2013, Local Authorities have the responsibility to commission a uniform and universal vascular risk assessment and primary prevention programme called the NHS Health Check (NHS HC), this is one of the eight mandated services that North Yorkshire County Council (NYCC) has to provide. The NHS HC programme will target all individuals aged 40-74 without previously diagnosed cardiovascular disease (CVD), diabetes or chronic kidney disease (CKD) to offer appropriate lifestyle interventions and treatment to reduce their overall risk and to reduce substantially the risk of premature death or disability. The programme is also intended to raise awareness of alcohol consumption above recommended levels and of dementia in older age groups aged 65-74. The purpose of the attached report is to highlight NHS HC performance in North Yorkshire (NY) County. The report shows NHS HCs performance comparison of Clinical Commissioning Groups (CCGs), with North Yorkshire overall and national performance targets. This paper will focus on Scarborough and Ryedale CCG (S&R) annual performance of 2016/17. It will provide an overview of key performance and any pertinent issues. At present all 15 General Practices are signed up to deliver the NHS HC programme. Each year practices are targeted with inviting 20% of the eligible population over a 5 year cycle. For S&R, 16.8% of their eligible population was invited for an NHS HC, this is slightly lower than the England average (17%) and marginally better than NY (16.5%) average. Within S&R, of those offered an NHS HC, 45.6% received a health check, this is in line with North

Transcript of Item Number: 264. PRIMARY CARE CO · PDF fileNHS Airedale, Wharfedale and Craven CCG AWC NHS...

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Our Vision – to Improve the Health & Wellbeing of our Communities

Item Number: 264.

PRIMARY CARE CO-COMMISSIONING COMMITTEE MEETING Meeting Date: 20/12/17 Report’s Sponsoring Governing Body Member: Clare Beard, Public Health Consultant

Report Author: Jenny Loggie, Health Improvement Manager, Natalie Smith, Health Improvement Officer

1. Title of Paper North Yorkshire NHS Health Checks Annual Report 2016-17

2. Strategic Objectives supported by this paper: (check those which apply) ☐ To create a viable & sustainable organisation, whilst facilitating the development of a different,

more innovative culture

☒ To commission high quality services which will improve the health & wellbeing of the people in

Scarborough & Ryedale

☒ To build strong effective relationships with all stakeholders and deliver through effectively

engaging with our partners

☐ To support people within the local community by enabling a system of choice & integrated care

☐ To deliver against all national & local priorities incl QIPP and work within our financial resources

3. Executive Summary: From April 2013, Local Authorities have the responsibility to commission a uniform and universal vascular risk assessment and primary prevention programme called the NHS Health Check (NHS HC), this is one of the eight mandated services that North Yorkshire County Council (NYCC) has to provide. The NHS HC programme will target all individuals aged 40-74 without previously diagnosed cardiovascular disease (CVD), diabetes or chronic kidney disease (CKD) to offer appropriate lifestyle interventions and treatment to reduce their overall risk and to reduce substantially the risk of premature death or disability. The programme is also intended to raise awareness of alcohol consumption above recommended levels and of dementia in older age groups aged 65-74. The purpose of the attached report is to highlight NHS HC performance in North Yorkshire (NY) County. The report shows NHS HCs performance comparison of Clinical Commissioning Groups (CCGs), with North Yorkshire overall and national performance targets. This paper will focus on Scarborough and Ryedale CCG (S&R) annual performance of 2016/17. It will provide an overview of key performance and any pertinent issues. At present all 15 General Practices are signed up to deliver the NHS HC programme. Each year practices are targeted with inviting 20% of the eligible population over a 5 year cycle. For S&R, 16.8% of their eligible population was invited for an NHS HC, this is slightly lower than the England average (17%) and marginally better than NY (16.5%) average. Within S&R, of those offered an NHS HC, 45.6% received a health check, this is in line with North

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Our Vision – to Improve the Health & Wellbeing of our Communities

Yorkshire (46%). S&R are therefore performing well. However, there will need to be significant improvements in uptake to reach the national aspirational target of 75%. The proportion of people offered an NHS HC and the proportion of NHS HCs received are the key indicators for the success of the programme. Only one practice from the seventy practices within NY achieved the set targets (20% invite & 75% uptake) this practice was in the HRW area. Everyone who has an NHS HC, should be given clinically appropriate lifestyle advice, to help them manage and reduce their risk. Where appropriate, some individuals will benefit from a referral to a lifestyle service. The referrals to lifestyle related services were significantly higher in S&R (8.2%) when compared to the NY average (4.5%). Further referral data by service, can be seen on Page 8 of the attached report. As part of an NHS HC, individuals may be defined as having a 20% or greater risk of having or developing Cardiovascular Disease in the next 10 years, this is known as ‘high risk’. For S&R 5.2% of all people who received an NHS HC in 2016/17 were identified as ‘high risk’. This is marginally higher than the NY average (5.0%), and an additional 4.6% of individuals received a new diagnosis, which is better than the NY average (3.7%). The NHS HC provides an opportunity to detect and diagnose long term conditions, such as diabetes, chronic kidney disease and hypertension. Latest data shows that diabetes has an expected prevalence of 9.0% for North Yorkshire (2017, PHE). Therefore, the NHS HC is an opportunity to diagnose undetected diabetes, and will be a link to the National Diabetes Prevention Programme (NDPP). There are opportunities for improvement in all aspects of the NHS HC programme the priorities are to increase the uptake, continue to support practices with the transition from Questbrower to Outcomes 4 Health data collection tool, support the implementation of the NDPP and improve the links with lifestyle services. NYCC, as commissioners of the programme would welcome any feedback regarding the NHS HC programme to ensure the programmes continual development. As commissioners, there are opportunities to make recommendations to PHE regarding this national programme. 4. Risks relating to proposals in this paper: N/A 5. Summary of any finance / resource implications: N/A 6. Any statutory / regulatory / legal / NHS Constitution implications: N/A 7. Equality Impact Assessment: N/A 8. Any related work with stakeholders or communications plan: N/A 9. Recommendations / Action Required The Primary Care co-commissioning committee is asked to note the content of this report and continue to support and promote the programme amongst primary care colleagues.

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For further information please contact: Name: Clare Beard, PH Consultant, Jenny Loggie, Health Improvement Manager, Natalie Smith, Health Improvement Officer

Title: ☎:

10. Assurance

North Yorkshire NHS Health Check Annual Report 2016/17

In partnership with

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North Yorkshire NHS Health Check

The purpose of this report is to highlight NHS Health Check performance in North Yorkshire. The report shows NHS Health Checks performance during 2016/17 for each Clinical Commissioning Group (CCG). Comparison is made between other CCGs in North Yorkshire along with comparisons with national performance targets and previous CCG performance. This report also provides the Commissioners (North Yorkshire County Council) with an opportunity to reflect on NHS Health Check related activity that has taken place over the year.

Two key pieces of data are currently submitted by practices, collated by North Yorkshire County Council (NYCC) Public Health Team and then submitted to Public Health England:

• Proportion of those eligible offered an NHS Health Check (working towards 20% of eligible population every year over five years)

• The uptake rate: the number of NHS Health Checks received as a proportion of the number offered (national target 75%)

These two indictors are used to compare the programme between areas and are seen as the key performance measures.

Table 1: Clinical Commissioning Groups names and abbreviations used in this report

CCG name Abbreviation

NHS Airedale, Wharfedale and Craven CCG AWC

NHS Cumbria CCG** CBA

NHS Hambleton, Richmondshire and Whitby CCG HRW

NHS Harrogate and Rural District CCG HaRD

NHS Scarborough and Ryedale CCG S&R

NHS Vale of York CCG** VOY

** With regard to NHS Airedale, Wharfedale and Craven, Cumbria and Vale of York CCGs this report only contains information for the practices that are located within North Yorkshire.

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This report excludes practices that are not signed-up for delivering the NHS Health Check programme (table 2), and therefore does not fully represent the total eligible population for the County. Similarly, it is important to note that the number of people aged 40-74 eligible for an NHS Health Check is calculated differently for GP practices compared to larger geographies, such as local authorities. Consequently, when aggregated up to County level, the resident population aged 40-74 calculated from GP registered patients will be different to that calculated from ONS population data, because of the difference in data sources.

Table 2: Number of GP Practices contracted Vs not contracted to deliver the NHS Health Check Programme

CCG GP Practices contracted GP Practices not contracted

AWC 4 -

CBA 1 -

HRW 21 1

HaRD 17 -

S&R 15 -

VOY 12 2

NHS Health Check offered to the eligible population

Practices are required to invite 20% of their eligible population each year over a five year cycle.

For North Yorkshire (NY), the percentage of those eligible and whom were offered an NHS Health Check decreased in 2016/17 (16.5%) compared to the previous year 2015/16 (18.5%). Two (AWC and HaRD) of the CCGs performed significantly better than the NY average. In contrast HRW (13.7%) and VoY (14.5%) CCGs achieved significantly lower than the England and NY average, showing that the practices within these CCGs invite significantly fewer of their eligible population. This is highlighted within Figure 1 below.

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Figure 1: Percentage of NHS Health Checks offered to the total eligible population in 2016/17 by CCG

During the last four years, the percentage of eligible population invited has seen some variation and fluctuation. It is important to reflect on the activity over the last years, to highlight the improvements made and acknowledge where further work needs to be done to reach all those eligible for a health check. If this figure continues to fall over the five year cycle, all eligible individuals entitled to receive an NHS Health Check will not be offered one. The performance over the last four years is identified in Table 3 below.

Table 3: Percentage of the eligible population invited for an NHS Health Check over the last four years, by CCG.

CCG 2013/14 2014/15 2015/16 2016/17 Total (cumulative)

AWC 17.1% 20.8% 18.8% 20.8% 77.5%

CBA 18.8% 21.5% 22.1% 15% 77.4%

HRW 13.9% 14.8% 15.6% 13.7% 58%

HaRD 15.7% 20.6% 19.7% 18.7% 74.7%

S&R 19.3% 20.3% 21.0% 16.8% 77.4%

VOY 12.5% 17.1% 17.2% 14.5% 61.3%

NY 16.2% 18.6% 18.5% 16.5% 69.8%

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As commissioners of the NHS Health Check Programme, we will continue to monitor this position closely and work alongside practices to improve the offer of an NHS Health Check to ensure we are reaching all of the eligible population.

NHS Health Check uptake

The percentage of NHS Health Checks received by those offered is mixed across the County, the uptake is highest in Cumbria CCG (56.3%) and lowest in HaRD CCG (42.5%). When compared to the North Yorkshire average (46%). Cumbria CCG (56.3%), VoY CCG (54.1%) and AWC (54.1%) have all performed significantly better than the North Yorkshire average. HRW CCG (46.1%) and S&R CCG (45.6%) are in line with the North Yorkshire average. HaRD CCG’s uptake is significantly lower when compared to the North Yorkshire average. Although the performance is mixed across North Yorkshire, four of the CCG areas have noted improved uptake rates from that reported in 2015/16.

Figure 2: The percentage of NHS Health Checks uptake in 2016/17 by CCG

As a County, North Yorkshire falls below the current national average (49.9%) for the percentage of NHS Health Checks received amongst those who were offered. However, this is in line with the national performance which has fallen since 2015/2016. North Yorkshire has performed well (ranked 9th) when

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compared to other areas of Yorkshire and Humber (49.3%) and uptake has increased when compared to 2015/16 figures. There still needs to be significant improvements in uptake to reach the national aspirational target of 75%. Since the provision of NHS Health Checks became the responsibility of the Local Authority (April 2013) it is important to recognise that the number of invites has declined slightly, which can be seen in Table 3, however uptake has increased.

Figure 3: The percentage of NHS Health Check invites and uptake in 2014-2017

Thus meaning, although fewer people have been invited more people have accepted the offer and are attending for an NHS Health Check.

Undeniably, these figures are only one part of the picture and do not tell the whole story. As commissioners, we want to ensure that we look at all elements of the programme, including both the quality and quantity of the NHS Health Checks delivered. The variation between CCGs is evident when looking alongside the risk management aspect of the data. Understanding the reasons which contribute to the noted differences across the County is crucial for the continual development of the programme. The use of audit, self-assessment tools and peer to peer review, will be central to us understanding this variation, and looking at ways in which the programme can develop and evolve.

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Identification of risk

The NHS Health Check is a preventative programme which is intended to help people live longer healthy lives by reducing cardiovascular disease. To maximise these benefits, everyone who has an NHS Health Check, should be given clinically appropriate lifestyle advice, to help them manage and reduce their risk. Where appropriate, some individuals will benefit from a referral to a lifestyle service. These services include but are not limited to stop smoking, weight management, exercise referrals and alcohol misuse services. The purpose of including this data is to bring attention to the bigger picture of the NHS Health Check programme; it presents an opportunity to discuss changes to individual lifestyle choices, and offer a referral in to services that can support patients to have a healthier lifestyle. Figure 4 below, shows the percentage of referrals made to services following an NHS Health Check.

Figure 4: The percentage of patients referred to lifestyle services such as stop smoking, weight management, exercise referral and alcohol substance misuse services following an NHS Health Check 2016/17 by CCG.

Overall referrals made to lifestyle services has increased significantly compared to that of 2015/16 (1.4%). Referrals to physical activity programmes has increased by 2.34% compared to 2015/16 data, referrals to weight management has also increased by 0.34% when compared to 2015/16 data. The referrals to lifestyle-related services were significantly higher in AWC and S&R CCGs when compared

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North Yorkshire NHS Health Check

to the North Yorkshire average. CBA, HRW and HaRD CCGs made a significantly lower number of referrals into lifestyle services in 2016/17 compared with North Yorkshire. It is unclear why there is such a large variation between the CCGs.

Table 4 highlights the numbers of people being referred into each lifestyle area, by CCG. There may be an under-reporting issue here as practices may not always code correctly when making a referral into a service.

Table 4: NHS Health Check referrals to lifestyle services (Numbers and Percentage) - 2016/17

Smoking Weight Management Alcohol Exercise

CCG N % N % N % N %

AWC 3 0.16% 1 0.05% 2 0.10% 213 11.11%

CBA 0 0.00% 0 0.00% 0 0.00% 0 0.00%

HRW 6 0.19% 13 0.41% 0 0.00% 37 1.17%

HaRD 14 0.31% 5 0.11% 1 0.02% 13 0.28%

S&R 18 0.57% 61 1.92% 3 0.09% 99 3.11%

VOY 1 0.04% 0 0.00% 1 0.04% 98 4.30%

NY 42 0.27% 80 0.52% 7 0.05% 460 3.00% Source: NYCC, 2017

NYCC is seeking to increase the number of referrals made to lifestyle services, in order to better support patients to improve their health outcomes. Practices are advised to use the most recent NHS Health Check template, provided by the Commissioner, to record the number of referrals made to lifestyle services. An example of the template can be found in the NHS Health Check Service Specification, Appendix 3 (April 2017) variation).

Further information on North Yorkshire County Council commissioned lifestyle services can be found on the recently updated GP portal, by using the following link http://www.northyorks.gov.uk/article/32337/Healthy-weight-and-physical-activity-signposting-tool

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Identification of High Risk

High Risk is defined as having a 20% or greater risk of having or developing cardiovascular disease in the next ten years.

Those categorised as “high risk” after having an NHS Health Check are shown in Figure 5 (below), as a percentage of all people who received an NHS Health Check in 2016/17. The percentage of people classified as high risk is significantly higher when compared to 2015/16 (3.6%) with variation across the County. HRW CCG had a lower percentage of patients identified as high risk when compared to the North Yorkshire average of 5%. VOY CCG had a significantly higher percentage of patients identified as high risk (6.7%) compared to the NY average (5%).

Figure 5: The percentage of people classified as high risk following an NHS Health Check in 2016/17 by CCG

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New diagnoses of conditions following completion of NHS Health Check

Figure 6 below shows the percentages of new conditions diagnosed of those who had an NHS Health Check completed. CBA CCG (6.8%) has a significantly higher percentage compared to the NY average of 3.7%; whereas AWC CCG (2.5%) has a significantly lower percentage compared to NY.

Figure 6: New conditions diagnosed as a percentage of those who received an NHS Health Check in 2016/17 by CCG

NHS Health Checks and Income

The percentage of income from an NHS Health Check and the potential total income if practices achieved 100% of the 20% invite target and the national 75% uptake target varies across North Yorkshire for 2016/17.

Only one practice from the seventy practices that signed up to deliver the service achieved the set targets. This practice was from HRW CCG. Table 5 highlights the potential income available for delivering the NHS Health Check programme, within each CCG. Improvements are needed throughout the providers delivering the

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NHS Health Check service to reach the national aspirational targets. The figures presented in Table 5, do not account for those practices that have chosen to not deliver the NHS Health Check, therefore some income and eligible population data is missing. Furthermore, individual practice income tables are reported locally, as part of the Practice Level NHS Health Check reports. Therefore, all providers are able to consider potential further income from delivering the programme.

Table 5: Income from NHS Health Checks 2016/17 and potential income if the practice meets full targets

CCG Income from NHS HC 2016/17

Income from NHS HCs if invite target and national uptake target are met

Lost income as not met the invite target or national target

Number of additional NHS HCs needed to meet the national uptake rate

The difference between the 20% invite target of the eligible population and the number of invites sent

Number of practices signed up

AWC £46,659 £59,703 £13,044 636 Target met 4

CBA £5,705 £9,685 £3,980 194 148.2 1

HRW £75,669 £165,186 £89,517 4367 3181.6 21

HaRD £111,266 £193,803 £82,536 4026 721.2 17

S&R £76,380 £138,674 £62,294 3039 1315 15

VOY £53,458 £102,098 £4,864 2373 1707.6 12

NY £369,138 £669,151 £300,012 14,635 6932 70

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Table 6: Average income loss by CCG and range of income loss by practices

CCG Average income loss by CCG

GP with the lowest loss GP with the highest loss

AWC £13,044.15 £246.00 £5,088.10

CBA £3,980.08 £3,980.08 £3,980.08

HRW £89,517.35 Target met £20,770.60

HaRD £82,536.08 £2,000.80 £10,750.20

S&R £62,294.38 £861.00 £12,458.88

VOY £48,640.35 £619.10 £9,959.93

Primary Care Approved Provider List:

During 2016/17, the Primary Care Approved Provider List was due to be renewed. The Approved Provider List is the mechanism by which the Commissioners contract with GP practices and pharmacies for the provision of specified public health services. As part of this process, it was agreed there would be a collaborative public health approach to consulting with the Local Medical Committee (LMC) and Community Pharmacy North Yorkshire (CPNY).

During this renewal, key proposed changes to the existing NHS Health Check service specification was negotiated with the LMC; significant changes were made to the payment structure and to the use of QuestBrowser (QB). QB is a web based system provider that supported GP practices to deliver and report activity for the NHS Health Checks Programme. The license access to QB was granted via a Memorandum of Understanding (MOU) with NHS England, Harrogate and District Foundation Trust, City of York Council and North Yorkshire County Council. Changes to the MOU resulted in North Yorkshire being unable to continue accessing QB. It was recognised that an alternative system was required in which GP Practices could continue to report activity. Outcomes4Health was implemented for providers to report activity, support commissioners to performance manage each programme area and generate payment for GP practices from 1st April 2017.

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Annual Report 2016/17

Finding the ‘Eligible Population’ for the NHS Health Check programme, was a function offered by QB. Alternative clinical system searches were developed in partnership with key practices and members of their teams, to ensure this key function would not harbour the continual delivery of the NHS Health Check programme.

Evaluation of the NHS Health Check Outreach Programme:

During January 2017, NYCC Public Health team evaluated the one year Outreach pilot service that was offered during November 15 – November 16. The Outreach service was in addition to the county-wide NHS Health Check service delivered in primary care, to address health inequalities. The Outreach service aimed to target those with the highest risk of developing vascular disease providing an agile, community-focused service that supports increased uptake.

The Outreach pilot had two approaches: one targeted at the Scarborough communities due to Public Health England (PHE) Health Profile for Scarborough in 2014 showing of the 32 indicators Scarborough performed significantly worse than the England average in nine indictors. The second approach was on the farming community of North Yorkshire due to them having been shown to have poorer access to health and social care services due to a number of factors including geography, rurality and perceptions of their own health and wellbeing

As part of the Community outreach scheme a total of 726 NHS Health Checks have been delivered in Scarborough and the Farming community. Table 7 presents the total number of Health Checks delivered against the set targets.

Table 7: Number of NHS Health Checks completed against performance targets set

Total HCs

Target No of HCs set for

Year 1

Remaining No of HCs

Performance against target

%

Target population achieved %

Scarborough Outreach

679 1573 894 43.17% 13.29%

Farming Outreach

47 426 379 11.03% 11.03%

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The number of NHS Health Checks completed in Scarborough increased gradually throughout the pilot. Footfall has been lower than expected in target ward venues, resulting in the provider completing significantly more “general” than “targeted” Health Checks.

A full review of the NHS Health Check outreach pilot service has allowed us to identify the benefits of providing an outreach NHS Health Check service, serving some of the most seldom seen populations in North Yorkshire. The findings and lessons learnt from the NHS Health Check Pilot Outreach are provided as an appendix. (see Appendix A for more details)

Getting Serious about Prevention 2017: Improving Cardiovascular Health Together

The NHS Health Check 2017 National Conference; Getting Serious about Prevention was held in Manchester. The event aimed to raise awareness regarding the importance of acting together to improve our efforts on preventing ill health and premature death from cardiovascular disease.

Public Health submitted a poster focusing on the findings of the NHS Health Check Pilot Outreach as mentioned above. Presenting findings at National Conferences allows best practice and evaluations to be shared amongst colleagues and other local authorities, which contributes to the continual development of Public Health interventions and enhances the evidence base. The poster has been provided as an Appendix. (See Appendix B for more details) .

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Future Programme Developments

There are opportunities for improvement in all aspects of this programme, particularly around invites offered and uptake rates.

The priorities for continuing to shape and develop the NHS Health Check programme over the course of 2017/18 are:

• Continue developing the clinical searches to ensure the eligible population is accurate, which supports precise invitation and that GP Practices are recording invites correctly.

• Consider how the NHS Health Check programme can take a targeted approach to reaching specific at risk groups.

• To ensure all eligible individuals in North Yorkshire are given equal opportunity to attend an NHS Health Check through working with GP practices that are not contracted to deliver the programme and those that are not engaged in delivering the programme effectively.

• Review the current delivery models, with a focus on equity of access .

• Continue to support practices with the transition from Questbrower to Outcomes 4 Health data collection tool.

• To improve links with health and support services such as stop smoking service and tier 2 lifestyle weight management services.

• Reflecting on the continual effective use of Audits across all providers, considering how a peer support approach can be adopted.

• To work with Public Health England (PHE) to develop an NHS Health Check Service Self – Assessment Tool that will be based on the “NHS Health Check programme standards: framework for quality improvement”. The national standards set out what a good NHS Health Check programme looks like and provides a framework to ensure that the programme operates within defined parameters.

• To support the implementation of the National Diabetes Prevention Programme across all three STP footprints.

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General Recommendations:

1. Practices should ensure that all staff involved in delivering NHS Health Checks remain up-to-date with training and refer to the latest advice and guidance. Providers can find support for staff training and competency here: http://www.healthcheck.nhs.uk/commissioners_and_providers/training/

2. Practices should ensure that all data is submitted and recorded using Outcomes 4 Health and staff are competent to use the system.

3. To raise awareness and highlight the benefit of the NHS Health Check programme to the eligible population across North Yorkshire through marketing campaigns at practice level.

4. Effectively contribute to Public Health England’s aspiration to achieve a national take up rate in the region of 75% of the eligible population having an NHS Health Check once in every five years, where they remain eligible.

5. To contribute to the achievement of Public Health Outcomes Framework (PHOF) indicators, relating to NHS Health Check programme objectives.

6. To achieve a minimum of 50% uptake rate for the invited 20% of the eligible population, per General Practice, per year (1 April to 31 March).

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The NHS Health Check is a key intervention aimed to improve the prevention of cardiovascular disease and reduce premature death. For CCGs, there is an opportunity to review local performance and make suggestions for service improvements, to benefit the local CCG population. In addition, CCGs can refer to the NHS RightCare CVD Prevention Optimal Value Pathway to look at optimising clinical management of high cardiovascular disease risk conditions, such as raised cholesterol and hypertension, this can be linked to CCGs strategic priorities, CVD strategies and the implementation of the National Diabetes Prevention Programmes.

If you would like to discuss this report and the development of the NHS Health Check programme please contact [email protected]

For further information about the NHS Health Check Programme nationally, please visit: http://www.healthcheck.nhs.uk/. This website hosts lots of supporting information for providers.

Acknowledgements:

Lincoln Sargeant, Director of Public Health Clare Beard, Public Health Consultant Jenny Loggie, Health Improvement Manager Natalie Smith, Health Improvement Officer Jacqui Fox, Health Improvement Officer Judith Yung, Public Health Intelligence Analyst

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Appendix A

Scarborough Outreach service

1. The number of NHS Health Checks completed in Scarborough increased gradually throughout the pilot.

2. The new provider required time to establish relationships in the area.

3. Where clinics were delivered in target wards, a significant number of people who engaged in the service do not reside in these areas.

4. Footfall has been lower than expected in target ward venues, resulting in the provider completing significantly more “general” than “targeted” health checks.

5. There has been a high level of interest in the service, however a large number of people (n=332) engaging in the service did not meet the eligibility criteria.

6. As a commissioner, we perhaps did not fully appreciate the initial level of work involved for the Practices to be able to receive the data from the outreach service.

7. Risk identified in relation to follow-up of patients referred from outreach to GP, where referrals are not accepted in a timely manner.

8. There appears to be significant interest in delivering NHS Health Checks in a workplace setting.

9. The NHS Health Check engaged with the 40-69 age range and identified a good proportion of them to have high risk factors.

10. Attendees were highly satisfied overall with the quality of service for the NHS Health Check, 100% rated it excellent.

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Farming outreach service

1. A form of health check is delivered by another organisation in North Yorkshire. The target audiences are the same. Although this check is less comprehensive than the NHS Health Check, the provider had established strong relationships with farmers and farming-related venues.

2. Clients reported that the time required to complete an NHS Health Check is too long. Although less comprehensive than the NHS Health Check, the alternative check delivered by the other organisation is more suitable, at under 20 minutes per check.

3. Feedback from those receiving an NHS Health Check through the outreach service has been positive, with a number being made aware of their cardiovascular risk for the first time.

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Introduction

North Yorkshire (NY) is the largest county in England. It serves a population of 607,000 covering 3,000 square miles. NY ranges from isolated rural settlements, farms, market towns and larger urban conurbations.

In overall terms, NY is an affluent county with generally good health outcomes. However, there are areas of profound deprivation, and inequalities are evident in health and income. North Yorkshire County Council (NYCC) launched an NHS Health Check pilot outreach service in November 2015. This targets those with the highest risk of developing vascular disease providing an agile, community-focused service that supports increased uptake.

Aim

To identify and reduce the risk of cardiovascular disease by improving access to the NHS Health Checks service, in particular for those at higher risk i.e. the farming community and those living in Scarborough.

Appendix B

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For further information contact: [email protected] or [email protected]

Outreach Health Check Activity | Jan - Nov 2016

100

80

60

40

20

0JAN

Number of participants

General Health Check

Targeted Health Check

Farming Health Check

FEB MAR APR MAY JUN JUL AUG SEP OCT NOV

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North Yorkshire County Council - NHS Health Check Outreach Service; a pilotPresented by Natalie Smith Authors: Jacqui Fox, Aoife Healy, Jenny Loggie and Clare Beard

Methodology

NYCC Public Health team implemented a pilot service in addition to the county-wide NHS Health Check service delivered in primary care, to address health inequalities. Evidence1,2 suggests that those in farming-related occupations have increased risk of cardiovascular disease. There are an estimated 17,000 people employed in farming related occupations across North Yorkshire. Scarborough has a higher prevalence of premature death from cardiovascular diseases3, compared to the national average and to North Yorkshire. An outreach service, delivered in community settings, was identified as the most appropriate way to address this.

Findings and Lessons Learnt

Scarborough Outreach service

1. The number of NHS Health Checks completed in Scarborough increased gradually throughout the pilot.

2. The new provider required time to establish relationships in the area.

3. Where clinics were delivered in target wards, a significant number of people who engaged in the service did not reside in these areas.

4. Footfall has been lower than expected in target ward venues, resulting in the provider completing significantly more “general” than “targeted” health checks.

5. There has been a high level of interest in the service, however a large number of people (n=332) engaging in the service did not meet the eligibility criteria.

6. As a commissioner, we perhaps did not fully appreciate the initial level of work involved for the Practices to be able to receive the data from the outreach service.

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Annual Report 2016/17

Conclusion

A full review of the NHS Health Check outreach pilot service has allowed us to identify the benefits of providing an outreach health check service, serving some of the most seldom seen populations in North Yorkshire.

References

1 Alston, M. and Kent, J., 2008. The Big Dry The link between rural masculinities and poor health outcomes for farming men. Journal of Sociology, 44(2), pp.133-147

2 Burnett, T. and Mort, M., 2001. Improving Access to Healthcare for Farming Communities. The Farmers' Health Project. Institute for Health Research, Lancaster University, Lancaster, Report to NHS Executive (North West) of Project RDF/LSC/99/0037.

3 Public Health England. 2015. Health Profile; Scarborough District.

7. Risk identified in relation to follow-up of patients referred from outreach to GP, where referrals are not accepted in a timely manner.

8. There appears to be significant interest in delivering NHS Health Checks in a workplace setting.

Farming outreach service

1. A form of health check is delivered by another organisation in North Yorkshire. The target audiences are the same. Although this check is less comprehensive than the NHS Health Check, the provider had established strong relationships with farmers and farming-related venues.

2. Clients reported that the time required to complete an NHS Health Check is too long. Although less comprehensive than the NHS Health Check, the alternative check delivered by the other organisation is more suitable, at under 20 minutes per check.

3. Feedback from those receiving an NHS Health Check through the outreach service has been positive, with a number being made aware of their cardiovascular risk for the first time.

North Yorkshire NHS Health Check

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