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NHS Health Checks

Why is it important? 

The NHS Health Check (NHS HC) programme is a primary care intervention programme that was introduced in 2009 to help:

  • Prevent more people developing cardiovascular diseases (CVD) and associated conditions, including heart disease, stroke, diabetes and kidney disease, through early detection of risk factors,
  • Support individuals to reduce behavioural and physiological risks through evidence‑based interventions, with the aim of lowering CVD‑related mortality rates.

Everyone aged 40 to 74 who has not already been diagnosed with one of the specified conditions, will be invited (once every five years) for a check to assess their risk of heart disease, stroke, kidney disease and diabetes. They will also receive support and advice to help reduce or manage that risk. A high take up of NHS Health Check is important to identify early signs of poor health leading to opportunities for early interventions. 

CVD is one of the top leading causes of premature deaths (i.e. deaths occurring before the age of 75 years) in England. CVD accounted for 22.6% of all premature deaths recorded in 2023 in England, the second highest cause of premature mortality after cancer (35%). Equally, stroke is one of the main causes of disability in England. The number of people being admitted to hospital following a stroke has risen by 15% in the last ten years, from 2014/15 (85,031) to 2023/24 (97,843). And according to NHS England – North West, 50% of stroke survivors will be left with disability (physical, communication, cognitive, psychological, visual, fatigue).

What is the current position in Salford? 

The NHS Health Check programme is evaluated against two key metrics:

  1. The number of eligible people invited.
    Over each 5‑year cycle, 100% of the Total Eligible Population (TEP) must be invited. This equates to an annual target of inviting 20% of the eligible population.
  2. The number of NHS Health Checks completed.
    By the end of the 5‑year cycle, at least 75% of those invited should have completed a health check. This represents an annual completion target of 15% of the TEP.

Five-year performance:

In the five years up to 2024/25, Salford invited a total of 50,468 people for an NHS HC, equivalent to 77% of the TEP (65,376 residents). This was 23 percentage points below the national five‑year target, which requires 100% of the TEP to be invited.

Of those invited, 23,886 people completed an NHS HC, representing 37% of the TEP. This completion rate was below the programme’s 5‑year target, which requires 75% of the TEP to receive an NHS Health Check.

By comparison, 76% of the eligible population were invited nationally, and only 30% took up the health check. Salford performance exceeded these national rates on both measures, with the local performance improving markedly in recent years.

Health check invites:

Over the past 24 months (2023/24 to 2024/25), Salford consecutively exceeded the annual minimum target for NHS Health Check invitations and outperformed the England average:

  • In 2023/24, 55.2% (35,932 people) of the Salford TEP (65,114) were invited for a health check. That was 35.2 percentage points above the national target of 20%.
  • In 2024/25, 49.4% (32,264 individuals) were invited, corresponding to 29.4 percentage points above the target.
  • By comparison, the England average was 22.1% in 2023/24 and 24% in 2024/25.
    Salford has seen a big increase over recent years in the share of eligible people being invited for an NHS Health Check

[Download the NHS Health Check invited chart (csv format, 1kb)]

Health checks received:

Salford has consecutively exceeded the national minimum annual target of 15% for NHS Health Checks completed over the last two years of the five-year programme period, and performed better than the England average:

  • In 2023/24, 13,103 individuals in Salford received a health check, equating to 20% of the eligible population. This uptake was five percentage points above the national annual target of 15%, and 11.2 percentage points higher than the England average of 8.8%.
  • In 2024/25, 13,569 people in Salford completed a health check, representing 21% of the eligible population. This exceeded the national programme target of 15% by six percentage points. By comparison, only 9% of the eligible population in England received an NHS Health Check during the same period, 12 percentage points lower than Salford’s performance.

In the last two years Salford has performed above the target for the number of Health Checks delivered

[Download the NHS Health Check received chart (csv format, 1kb)]

Who is most affected? 

To be eligible for an NHS Health Check you need to be aged 40-74 years and have not had an NHS Health Check within the last five years. People who have been diagnosed with one of the following conditions, or who are taking medication for one of these conditions are not eligible for an NHS Health Check as their health should be monitored already:

  • Stroke or Transient Ischaemic Attack (TIA)
  • Heart Disease or Heart Failure
  • Diabetes
  • Chronic Kidney Disease (Stages 3-5)
  • High Blood Pressure
  • Atrial Fibrillation
  • High Cholesterol
  • Heart Attack

Populations with higher levels of risk and undiagnosed disease are more likely to benefit from programmes such as the NHS Health Check programme. According to a 2019 Public Health England report on preventing cardiovascular diseases (CVD), people living in the most deprived communities are 30% more likely to have high blood pressure, which is the biggest single known risk factor for heart attack and stroke. Also, 40% of amenable CVD deaths occur within the 3 most deprived deciles nationally.

Furthermore, according to a 2024 qualitative research study with peer researchers on barriers and facilitators of NHS health checks in socioeconomically deprived communities in the North East of England, uptake of the NHS Health Check programme remains inequitable, particularly among individuals from socioeconomically deprived communities: Women, older individuals and those from higher socioeconomic backgrounds are more likely to attend, while men, smokers, and those from deprived backgrounds are less likely to engage. Key factors to that poor engagement include: 

  • Psychological barriers - fear of diagnosis. Participants expressed anxiety about discovering health problems, influencing their willingness to engage with the health checks service providers.
  • Trust in healthcare professionals - Participants reported mistrust stemming from previous negative experiences or perceptions of stigma.
  • Limited public awareness, which emerged as a significant barrier, with participants frequently describing being unaware of the programme or unclear about its purpose. 
  • Accessibility and logistical barriers - Participants highlighted issues such as inconvenient appointment times, long waiting periods, and difficulties navigating GP systems, which compounded existing inequities in accessing healthcare.

For some people it is even more important that they have an NHS HC as they may be at a higher risk of some of the conditions the health check can help to identify. Ethnic minorities particularly from Asian, Black African/Caribbean background are at higher risk of hypertension, high blood pressure, and type 2 diabetes.

Heart disease is more common among men and men are more likely than women to die early due to heart disease

What can be done? 

Further improvements in the delivery of the NHS HC Programme can be broken down into three components:

1 Maximising Take‑Up

1.1 Among socio‑economically deprived communities

Key barriers include low awareness of the programme, cultural norms around self‑reliance, fear of diagnoses, and mistrust of healthcare systems.

Improvements:

  • To provide clear information on what the health check involves and emphasise the benefits of early detection to reduce anxiety.
  • To build trust by involving respected community leaders and local healthcare professionals.
  • To increase accessibility by offering evening/weekend appointments and delivering checks in community settings (e.g., hubs, libraries).

1.2 Among high‑risk communities

Targeted efforts are needed for groups with higher risk or lower engagement:

2 Improving the Quality of NHS Health Checks Delivered

There is significant variation in the delivery of NHS Health Checks nationally in relation to invitations, uptake, delivery and follow-up. As NHS HCs are a key route for identifying people at risk of CVD and diabetes, it is essential that the programme reaches the right people, and consistently includes all elements to optimally assess individual risk, with onward referral to the appropriate treatment pathways.

To this end, local action can be taken to:

  • Build system capacity and capability within the workforce through regular face-to-face training and refreshers.
  • Scrutinise local delivery to ensure adherence to national quality standards.
  • Share examples of best practice across the Primary Care Networks, as well as providing additional support to GP practices that may be struggling.
  • Monitor the identification to treatment conversion rates of individuals with CVD and diabetes, to ensure they receive timely and appropriate treatment interventions.

3 Strengthening NHS Health Check Delivery

The delivery of NHS health checks in Salford was significantly reduced during the early part of the last five year cycle, which negatively affected uptake. This reduction was due to the COVID-19 lockdown restrictions and the subsequent post pandemic recovery period. To improve performance, the following actions were taken:

  • From April 2023, NHS HCs were included in the Salford Standard, a scheme that aims to address variation of care across the city, providing an incentive for GPs to prioritise NHS HC delivery in order to promote recovery.
  • Additional support was provided to GPs, through the council’s Health Improvement Service (HIS), with the latter focussing on targeted engagement.
  • The Royal Society of Public Health (RSPH) NHS HC training sessions were offered to all Salford practices to upskill staff and expand in practice capacity for delivering more NHS HCs.

Where can I find out more?

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