A process evaluation of the NHS Health Check care pathway in a primary care setting

J Public Health (Oxf). 2015 Jun;37(2):202-9. doi: 10.1093/pubmed/fdv053. Epub 2015 Apr 28.


Background: More evidence is needed concerning the implementation of the NHS Health Check programme in order to identify areas for improvement. The aim of the study was to investigate the way in which the Gloucestershire NHS Health Check programme care pathway was followed and interpreted compared with national programme indicators.

Methods: A cross sectional review of Gloucestershire's Health Checks was undertaken to assess programme performance via a primary care audit of key indicators within a cohort of 83 GP practices and an eligible population of 210 513. Data were assessed to compare differences between practices and to compare county data with national indicators.

Results: The annual programme uptake was 49.8% and a total of 1031 patients were diagnosed with cardiovascular disease (CVD). Variations in the detection of modifiable risk factors in relation to the NHS Ready Reckoner were identified: diabetes (-0.04%), CKD (-0.9%), hypertension (-19.9%); obesity (-7.1%); low physical activity (-57.7%) and smoking (-14.3%).

Conclusions: Disparities in uptake and implementation of the care pathway demonstrate inconsistencies in the application of processes and knowledge. There appears to be an overestimation of CVD risk by the Ready Reckoner tool likely to be attributable to a failure to adjust for existing local early identification efforts in primary care and prevention.

Keywords: NHS Health Checks; chronic disease; circulatory disease; population-based and preventative services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Cross-Sectional Studies
  • England / epidemiology
  • Female
  • Health Priorities
  • Health Promotion / organization & administration*
  • Humans
  • Male
  • Mass Screening / organization & administration*
  • Middle Aged
  • National Health Programs / organization & administration*
  • Primary Health Care / organization & administration*
  • Process Assessment, Health Care*
  • Public Health Practice*
  • Quality Improvement*
  • Quality Indicators, Health Care
  • Quality of Health Care
  • Risk Assessment
  • Risk Factors
  • State Medicine / organization & administration*