The Barnsley Health Check Evaluation Project

Identifying and sharing best practice in the NHS Health Check Programme in

Barnsley

Dr Annette Haywood & Dr Shona Kelly

CLAHRC for South Yorkshire

These findings represents independent research by the Health Inequalities Theme of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for South Yorkshire (NIHR CLAHRC SY). The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health. CLAHRC SY would also like to acknowledge the participation and resources of our partner organisations.

The Project Team

Sheffield Hallam University Dr Hanif Ismail (lead author)Dr Shona Kelly 

University of SheffieldProfessor Liddy GoyderDr Annette HaywoodDr Jill ThompsonDr Sheila KennedyMrs Susan Wilson  

Project Aims

• To describe the method of ‘high performing’ practices delivering the Health Checks by highlighting what works well, and why.

• To develop recommendations from the evaluation findings to guide other GP practices in how to maximise uptake of the Health Checks.

Presentation Outline

• Sampling/Methodology• Recruitment/Interviews• Findings• Conclusions• Recommendations• Integrated findings from 3 Yorkshire

programmes

Sampling/Methodology

• Identified 10 ‘top performing’ practices (70%+ over 4 years)

• Clinical and administrative staff (GP’s; Practice Managers; Practice Nurses; Health Care Assistants)

• Qualitative design - One to one/Group interviews

Recruitment/ Interviews• Aimed to conduct interviews with 1 to 3

staff per practice (manager/member of staff delivering HC) 2 practices declined

• 6 practices in most deprived quintile (96% categorised as ‘White British’)

• 4 mixed areas• 23 clinical and administrative staff :

14 individual interviews

9 in group interviews (3 per group)

Practitioner interviews by GP practiceNo. Int

Job title %** Deprivation

(pentile)Number

ofGPs

size

3 Practice Manager, Health Care Assistant and Administrator (interviewed together)

70% 2nd 4+ Large

2 GP and Admin Assistant (interviewed separately) 70% 2nd 

1 Small

2 Practice Nurse and GP (interviewed separately) 70% 2nd 1 Small3 Practice Manager, Nurse Practitioner, Admin

Secretary (interviewed separately)70% 4th 1 Small

3 Practice Manager, Practice Nurse, Receptionist (interviewed together)

70% 2nd 1 Small

3 Assistant Practice Manager, Practice Nurse, Health Care Assistant (interviewed together)

60% 5th 4+ Large

1 Practice Nurse 70% 4th 2 Small2 Practice Manager and Health Care Assistant

(interviewed separately)60% 3rd 4+ Medium

1 Admin Secretary 70% 5th 3 Medium3 Practice Manager, HCA, Secretary (reception

and admin) (interviewed separately)70% 3rd 3 Medium

   Total

 23

   Average Barnsley GP

practice size 6,589

Small: <less than 4000, medium 4,000-10,000, large 10,000+. * - number of interviewees ** % percent of eligible population

Findings

Common Themes:• Pro-active approach • Barriers to being pro-active• Team characteristics• Appropriate follow up• Barriers to follow up

Pro-active approach

• Using a variety of different methods in addition to invitation letter

• Re-writing invitation letter to be more ‘patient friendly’ – e.g. ‘healthy heart’ rather than ‘CVD assessment’

• Credit card sized reminders ‘know your score’

Barriers to being pro-active

• Fasting blood tests, so appointment times were limited:

“They have to have the fasting blood tests. … it does put a bit of a time restraint on if someone can’t come at five o’clock teatime because they can’t fast all day”

• Lack of follow up literature:“ .. the people who are doing the programme should think about doing some kind of leaflet which is specific and talks about the risk assessment in the leaflet and talks about lifestyle changes so it makes it relevant to the test that they’ve just had done”

Team characteristics

• A number placed responsibility for the success firmly with their staff team

“We have really, really good proactive staff in this practice”

• Defined roles/cohesive team“We’ve got four Practice Nurses and two Health Care Assistants and we work really closely together as a team”

• Going ‘above and beyond’ the routine“If you get somebody who is moderate health risk and you think they are going to be high in five years, if you get them back before you are going to keep them at moderate. Although not funded for it, we do it as an extra because it works out beneficial in the end”.

Appropriate follow up

• Individual approach important“I think I am quite flexible if I see somebody and think right I have only got twenty minutes, I am not going to do all that. That patient needs more support. We need to get them on board. I make my own appointments so I will get them back and back, if the patient is willing to come back”

• Ability to offer non-clinical follow ups“We do have health trainers at the surgery so we help with obesity and any life style changes that patients want to make”

Barriers to follow up

• Lack of availability of lifestyle changing follow up activities

“They don’t do exercise referrals anymore. They have stopped doing that. It is just people talking about diet which is a bit boring. Because we had a twelve month contract with the gym and they loved it”

• ‘Household approach’ required“ … their family life and everybody in their family smokes, they all eat unhealthily. It’s very difficult to educate these people. I don’t think we’re set up in primary care to do that you need people more community based going into people’s homes and talking to a whole family”

Conclusions• No differences based on practice size or

deprivation level• An approach that had developed and evolved

over time• All practices used a number of different

techniques to encourage uptake• Enthusiasm and commitment of staff a key driver

for success• Particular roles rather than ‘ad hoc’• Consistent approach

Recommendations

• Freedom to customise the approach• Be pro-active and persistent/use opportunistic

approaches• Flexible regarding appointment times• Patient focused literature and clear follow up guidance• Individual with overall responsibility for Health Check• Baseline training/education for staff• Evaluate if targets are being met• Encourage an ethos of ‘prevention is better than cure’

Integrating findings from across Yorkshire

Shona Kelly

Hanif Ismail

Integration Background

• Insights gained from 3 Health Check evaluations in Leeds, Barnsley and Rotherham

• Key finding– NO difference in success by deprivation level

of the patients– NO difference by size of practice

• Very limited 'hard' data• 5 key factors for HC success

1. Leadership and Ownership

– A keen person at the top will drive the HC programme

– Younger GPs have been trained in evidence-based medicine and screening effectiveness so challenge the efficacy

– Beyond the recent competencies framework• all staff need to understand WHY they are doing

Health Checks• staff need to learn how to present 'risks'

2. Infrastructure

• External factors out of their control• Some practices literally lack the space to

– run a Health Check– set up follow-up activities like weight

management clinics– rapid demographic change

• Behaviour change is a long term commitment for patient and practice

3. Financial benefit

• Not always seen as economically viable• Effort v reward• Benefit v cost• Feel they do health checks anyway• Don't recognise it is targeted to most

deprived groups

4. Interrogating their own records

• Lack the IT skills to interrogate their own records

• Can use the (hopefully) supplied programme to produce the targeted patients

• Can't do more than the basics

Recommendations

• Get evidence of effectiveness not just attendance– will need to provide IT support to generate this

• Need to better describe GP Practice needs– quality geospatial measures– record-based measures of case mix, and age

and ethnicity composition.