Contents:
1. Background
2. Service Aims
3. Service Specification
4. Clinical Governance Arrangements
5. Criteria for Eligibility
6. Reporting, Monitoring and Payment Arrangements
Driven by:
Public Health
Outcomes
Framework
North
Clinical
Somerset
Commissioning
Group’s Clear and
Credible Plan
North Somerset
Council’s Corporate
Plan
Vascular diseases include heart disease, stroke, diabetes and kidney disease and are the biggest cause of death in the UK. Vascular disease also makes up approximately a third of the difference in life expectancy between the most deprived and the least deprived areas in North Somerset. The
NHS Health Check programme helps ensure greater focus on the prevention of vascular diseases, and will help people remain well for longer.
The NHS Health Check is part of North Somerset Clinical Commissioning Group ’s ‘Clear and
Credible Plan’ to prevent people from dying prematurely and close the gap in life expectancy between the most and the least deprived wards. Increasing uptake of this service has been identified as a key priority for North Somerset Clinical Commissioning Group.
A health equity audit in North Somerset has demonstrated that in more deprived areas there are greater levels than would normally be expected of undiagnosed CHD, people presenting late to their
GP or hospital and higher mortality rates from CHD. Late diagnosis of these conditions is associated with poor health, disability and premature death. The NHS Health Check is a key approach to identifying those people with undiagnosed disease.
The service specification for Community Pharmacy to deliver the NHS Health Checks is being introduced to expand capacity, enable fair access and increase choice and for people who may not attend their GP for an NHS Health Check, particularly those living in more deprived areas.
NHS Health Checks is a national programme which is designed to identify and manage the risk of a cardiovascular incident within the next 10 years for people aged 40 to 74 who are not already identified and included on specified disease registers. It aims to identify those at risk of, or with early signs of, high blood pressure, raised lipid or blood glucose levels, and contributory factors including being overweight, smoking, excess alcohol consumption and physical inactivity. It also seeks to raise awareness of vascular dementia in the 65 – 74 age group. The NHS Health Check programme encompasses appropriate referral to pharmacological and non pharmacological treatments for the management of risk, and the follow up and ongoing management of those at the highest risk. It is expected that this programme will go some way to identify the undiagnosed population with existing cardiovascular disease, who will then be managed on existing disease pathways within primary care for secondary prevention.

When fully implemented in North Somerset it is estimated that each year as a direct result of having an NHS Health Checks approximately 84 people with diabetes will be diagnosed, 315 people with high blood pressure and in need of medication will be diagnosed and 218 people with kidney disease will be diagnosed. Many more with risk factors such as smoking, overweight, poor diet, excess levels of alcohol intake and low levels of physical activity will be advised, encouraged and assisted to make lifestyle changes to reduce risk of developing disease in the future.
3.1 Provision of NHS Health Checks
I. Provision for opportunistic NHS Health Checks for eligible people (as defined in section 3.2) who are unlikely to respond to an invitation from their GP or are unable
II. to get an appointment within two weeks at their GP practice.
Publicity, word of mouth, distribution of leaflets and other methods should be used by the pharmacy to encourage eligible people to have an NHS Health Check. Publicity material will be provided by Public Health.
III.
IV.
V.
Provision for self referral for people who have been notified by GP letter that the pharmacy will provide an NHS Health Checks (provided they are not excluded due to the conditions in section 6.)
Following agreement with the commissioner, and in partnership with a GP practice, a programme for sending invitation letters and follow up, to invite GP patients directly to the pharmacy for an NHS Health Check, may be introduced.
The information leaflet developed by the Department of Health should where possible, be provided to the person in advance of the NHS Health Check. Public
VI.
Health will make these leaflets available to pharmacies providing the service.
The pharmacy will ensure that people presenting for an NHS Health Check are informed about the process of the service and given the opportunity to ask questions.
People will be required to agree to the assessment and the communication of results to their GP. This agreement will be captured on PharmOutcomes.
3.2 Eligibility for NHS Health Check
I. All North Somerset Community Pharmacies are eligible to provide NHS Health Checks although
Public Health may prioritise the Pharmacies in areas of highest need or where there are gaps in provision.
II. People will be eligible for this service if they meet the criteria below:

Aged 40 to 74

With no known existing cardiovascular diseases

Have not received an NHS Health Check within the last 5 years
People who have Chronic Kidney Disease stages 1 and 2 or blood clotting diseases such as haemophilia and Hughes syndrome can be included provided they not have an existing vascular disease
III. People who are on the following disease registers are excluded from the programme as they will already be managed using existing care pathways.

Coronary heart disease,

Chronic kidney disease (CKD stages 3-5)

Diabetes

Previous stroke
IV. In addition, people who have been diagnosed with the following are also excluded:

Hypertension

Atrial Fibrillation


Transient Ischaemic Attack (TIA)

Hypercholesterolamia

Heart failure

Peripheral Arterial Disease (PAD)
V. Pharmacies are also advised to exclude people on palliative care registers where this can be determined
VI. People who are outside this age group or excluded for any reason and who are concerned about their risk of vascular disease or who have symptoms should be advised to contact their
GP.
3.3 NHS Health Check Process
I. Consenting eligible people will have the following parameters measured and recorded on the
PharmOutcomes template:
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


Blood pressure
Smoking status
Body Mass Index
Pulse (recommended but optional)
Physical activity levels using the General Practice Physical Activity Questionnaire
(GPPAQ).





AUDIT-C screening tool for alcohol consumption
Total cholesterol and HDL cholesterol levels
Family history of diabetes, premature heart disease
Ethnicity
In addition, those aged 65-74 should be made aware of the signs and symptoms of dementia and sign posted to memory services if this is appropriate
II. Vascular risk will be assessed using the risk assessment engine QRISK® 2 i provided on the
PharmOutcomes template.
III. The level of risk (high, moderate, low) will be communicated to the person using a motivational interviewing approach. An individually tailored management programme, with appropriate advice, support and interventions, depending on the level of risk identified, will be agreed using the Results Booklet – provided by Public Health. The pharmacist will actively involve the person in agreeing what advice and/or interventions they will follow. Any decisions must be made in partnership with the person.
IV. Refer as appropriate to lifestyle support services (as outlined in the North Somerset NHS
Health Checks Toolkit)
V. Describe the links between cardiovascular diseases and dementia for people aged between 65 and 74. Explain how risks of developing dementia may be reduced and signpost those who are concerned about their memory to speak to their GP who may refer for a memory assessment.
This should reflect the approach used in the on line training module referred to in the clinical governance section of this service specification (this may be extended to the younger age group if felt to be appropriate).
All details of the NHS Health Check will be forwarded to the person’s GP so that records may be updated (see details in section 7).
3.4 Referral to GP Practice
A person will be referred to their GP Practice, in line with NHS Health Check: Vascular Risk
Assessment and Management Best Practice Guidance ii when:
I. BMI is greater than 30 (27.5 or over in individuals from Indian, Pakistani,
Bangladeshi, Other Asian and Chinese ethnicity categories) or blood pressure that is at or greater than 140/90 mmHg, to have an assessment of their blood glucose.

(Fasting glucose or HbA1c is not included in the risk assessment because it is not considered to be clinically effective or cost effective to test everyone. The Department of
Health publication: NHS Health Check Programme: Best Practice guidance 2013 provides
II. further guidance on this ) blood pressure is at or greater than 140/90 mmHg so that an assessment of
III.
IV.
V.
VI. hypertension and chronic kidney disease can be carried out. found to be at high risk (>20%) as shown by QRisk2, for further investigation and management . In many cases these people will require pharmacological interventions and / or an intensive lifestyle programme for Impaired Glucose Tolerance/nondiabetic hyperglycaemia. pulse measurements indicate atrial fibrillation where pre-existing disease is suspected or identified. if aged 65-74 and concerned about memory
Where it is felt that referred people may not report to their GP practice it is advised that the pharmacy actively supports the person in making the appointment.
If there is any serious concern about the person’s immediate health the duty Pharmacist should ensure that the person sees a Doctor immediately.
3.5 Follow up - Develop and implement a protocol for follow up at 1 month to ensure people referred to their GP have attended an appointment. At least one Pharmacist plus dispensers or Health Care/counter assistants should attend a one day NHS
4.1 Competencies Assessments must be carried out by competent staff whose training meets the standards of the nationally developed competency framework. Staff will be audited to ensure that they meet these competencies. The Department of Health workforce competences for those carrying out vascular risk assessments can be accessed at:
. Competencies described in K12,
K13, K14, CHS132 and CMA7 are not relevant to delivering a health check in pharmacies and so not required.
These competencies are currently being updated and pharmacies will be notified when the new version is available.
4.2 One point of care testing unit will be provided to each pharmacy in the first year of delivery of the NHS Health Check service. Pharmacies are responsible for maintenance and replacement of the unit. Point of Care testing equipment for cholesterol must satisfy the standards contained in the guidance document and be capable of taking blood samples required for a QRISK2 assessment.
4.3 Pharmacies are expected to participate in the Point of Care Quality Assurance Programme commissioned by Public Health.
4.4 Pharmacies should ensure that all other equipment used in the Health Check (blood pressure monitor, height and weight measures) is fully functional, CE marked, validated, maintained and regularly calibrated.
4.5 It is the pharmacies responsibility to ensure staff dealing with blood products should have a
Hep-B vaccination and the blood test to check for immunity.
4.6 The service should be provided in accordance with the following guidance document and associated NICE Guidance: - Putting Prevention First: NHS Health Check: Vascular Risk
Assessment and Management, Best Practice Guidance

http://www.healthcheck.nhs.uk/news/nhs_health_check_programme_best_practice_guidanc e/
5.1 At least one pharmacist or Dispenser should complete the Health Checks training event provided by North Somerset Council and complete the online dementia awareness training ( http://www.healthcheck.nhs.uk/increasing-dementia-awareness-training-resource/ ), which will take around 30 minutes to complete.
5.2 Only staff who have completed these and can give evidence through a copy of the certificates, can deliver the NHS Health Checks.
5.3 In addition North Somerset Council Public Health will provide Motivational Interviewing Skills
Training (one day) which should be completed by those who need it to reach required competencies.
5.4 Clinical skills training sessions to carry out blood pressure readings, height, weight and point of care cholesterol testing should be completed by those who need it to reach the required competencies.
Pharmacies will be required to record activity using the PharmOutcomes template provided by
Public Health. A letter will automatically be printed for the person’s GP and sent by the most appropriate means (fax, letter or scan to e mail). The fact that the letter has been sent should be recorded on the PharmOutcomes template.
Payments will be based upon completion of an NHS Health Check as shown on PharmOutcomes, and evidence that the letter has been forwarded to the person’s GP. Payments will be made monthly according to data collected from PharmOutcomes.
Public Health reserves the right to introduce quarterly maximum and minimum number of NHS
Health Checks as the service embeds.
Pharmacies will receive £20.00 per NHS Health Check delivered.
In the first year of delivery a lump sum of £200.00 per pharmacy will be paid for development time to cover for staff to attend North Somerset Council’s Public Health training for the NHS Health Check, and set up costs such as purchase of blood pressure and height and weight measures where required. This will be paid in arrears at the end of the first quarter that the service commences.
(North Somerset Council will provide motivational tools for lifestyle change, such as fat and sugar demonstration models) i QRISK ® 2 is a UK registered trademark No. 2454356 owned by Egton Medical Information Systems
Limited and the University of Nottingham.
ii http://www.healthcheck.nhs.uk/news/nhs_he alth_check_programme_best_practice_guidance/