More guidance needed to motivate patients after NHS Health Checks, say healthcare professionals
The NHS Health Check is England’s flagship cardiovascular disease prevention scheme, but limited time with patients is making it hard for healthcare professionals to make multiple lifestyle interventions. What support do they need to ensure checks mean change?
23 Feb 2018, by Siobhan Chan
Your next patient – let’s call him Joe – walks in for his NHS Health Check. His blood cholesterol is high and he has a systolic blood pressure of 165mmHg; he smokes 10 cigarettes a day and has a BMI of 31.
Having run the standard checks, you have 10 minutes of appointment time left. You still need to walk Joe through his results, and find time to talk about lifestyle changes. He has several cardiovascular disease (CVD) risk factors: you can’t cover everything.
So, which do you prioritise for the most impact?
This was the question posed at a workshop on supporting behaviour change at a Public Health England hosted event in London in early February.
The NHS Health Check scheme, which is one of the largest CVD prevention programmes in the world, came under the spotlight at the conference Getting Serious about Cardiovascular Disease Prevention.
To date, around 6.1 million health checks have been carried out in England with a view to assessing the risk and spotting the early signs of stroke, kidney disease, heart disease, type 2 diabetes and dementia.
Early results published in 2016 suggest that at least 2,500 people have avoided a heart attack or stroke as a result of the programme1.
NHS Health Checks typically last around 20-30 minutes, according to best practice guidance, but many practitioners are pressed for time.
At the conference unpublished research revealed the difficulty healthcare professionals face in attempting to make several lifestyle interventions in a single, time- limited appointment. The report, by Samah Alageel, a researcher in the Department of Primary Care and Public Health Sciences at King’s College London, is based on GP and practice nurses’ views.
Ms Alageel’s work identified weight loss and alcohol consumption as particularly tricky subjects, because they can upset patients. “Some HCPs we surveyed thought more training or guidance was needed to help them coach patients through behavioural change interventions,” Ms Alageel says.
Back at the workshop, attendees discussed ways they could be better supported. Some said healthcare professionals lack the guidance and resources needed to discuss multiple lifestyle changes with a patient.
Time is a challenge
Nevertheless, the NHS Health Check is seen as a good opportunity to connect with hard-to-reach communities.
PHE Chief Executive Duncan Selbie, speaking at the opening session of the event, reiterated the importance of ensuring the programme reaches the most vulnerable people in society, and that patients are able to make lifestyle changes and receive treatment if necessary as a result of the checks.
“More important than people taking up [the health check] is what happens afterwards – the follow-through,” he said.
But those present discussed how, for some practitioners, there simply isn’t the time or capacity to follow up with these patients. And while some areas have a referral system in place for patients to attend a gym or join a local fitness group, this isn’t the case across England.
Let’s return to our patient, Joe. How do you discuss his results in a way that will motivate him to change his behaviour, knowing that you might not easily be able to follow up with him in six months’ time?
At the workshop, some thought that asking the patient what their view was about their general health could help to spot which parts of their lifestyle they are most motivated to change.
Attendees believed that picking one or two issues to discuss in detail would be more successful than overwhelming the patient with a long list of problems.
Would you do things differently? Share your experiences of delivering NHS Health Checks and let us know what resources or guidance would support you in discussing lifestyle changes with your patients on our BHF Healthcare Professionals LinkedIn Group.
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1. Robson J, Dostal I, Sheikh A, et al. The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open 2016;6:e008840. doi: 10.1136/bmjopen-2015-008840