PUBLIC HEALTH SERVICES
SPECIFICATION FOR: NHS Health Checks (Pharmacy)
1 December 2014 – June 2015
1.1 / CONTRACT MANAGEMENT:B&NES Council Representative: Cathy McMahon, Public Health Development and Commissioning Manager
Provider’s Representative: Larkhall Pharmacy
1.2 / AIM OF THE SERVICE:
To help prevent heart disease, stroke, diabetes and kidney disease
To raise awareness of the risk factors for cardiovascular disease, including lifestyle factors, and support people to avoid, reduce or manage those risks.
The programme also aims to reduce levels of alcohol related harm, and to raise awareness of the signs of dementia and where people can go for help
The programme aims to reduce health inequalities by targeting ‘hard to reach groups’ as a priority.
1.3 / BACKGROUND
The NHS Health Check is a risk assessment and prevention programme that identifies people at risk of developing heart disease, stroke, diabetes, kidney disease or certain types of dementia, and helps them take action to avoid, reduce or manage their symptoms of these health problems.
Together cardiovascular conditions are responsible for a third of deaths and a fifth of hospital admissions in England each year and cardiovascular disease accounts for the largest element of health inequalities in the UK. Vascular disease accounts for the largest number of deaths in people aged 65 and over in B&NES.
The total population of B&NES is 180,000 and of these, approximately 81,000 are in the 40-74 age groups. The estimated eligible population for an NHS Health Check minus those who are ineligible is 59,000 people. The check is once every 5 years, so around 12,000 people will be eligible for their check on an annual basis.
For further background information see Putting Prevention First NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance:
http://www.healthcheck.nhs.uk/commissioners_and_healthcare_professionals/national_guidance/
DESCRIPTION OF SERVICE:
The key service intervention is the prevention of Cardiovascular Disease through the systematic identification of patients who may be at high risk of developing CVD in the next 10 years based on QRISK 2 calculations, followed by primary prevention interventions.. Everyone attending a NHS Health Check will have their alcohol consumption risk assessed. In addition, people aged 65 -74 will be informed of the signs and symptoms of dementia and sign posted to memory clinics if needed. NHS Health Checks will be delivered both within GP surgeries and also as part of an outreach programme in a range of community venues including community pharmacy
Invitations
Offer letters will be sent out by GPs to invite people to contact their preferred provider to make an appointment for an NHS Health Check.
Appointment for risk assessment including blood test and lifestyle management advice
· Providers will provide an accessible service for working individuals by offering appointment times which include evening and/or weekend appointments for an NHS Health Check.
Providers will arrange an appointment to undertake an NHS Health Check including a cholesterol blood check (using point of care testing).
Appointments should be managed by the staff. It is recommended that at least 20 minutes be allowed for an NHS Health Check . The provider will check the eligibility of the person prior to delivering the Health Check. Providers may conduct the NHS Health Checks within their premises and/or utilise other service providers (e.g. libraries, community venues) and locations to improve access within localities and so maximise service provision.
Walk in provision
Pharmacies and Outreach providers will also offer a walk-in service (opportunistic) for people who have received an invitation letter via the GP and those people resident in B&NES but not registered with a GP.
The service provider will encourage people who are not registered with a local practitioner to do so.
NHS HEALTH CHECK DELIVERY
Providers will undertake a vascular risk assessment using the QRISK2 CVD risk assessment tool. The assessment will include a cholesterol blood test using point of care testing. Ideally this will be completed in a single appointment using a ‘one stop shop’ approach.
Providers are expected to follow the national vascular risk assessment and management programme guidance when undertaking a NHS Health Check (annex 1).
Best practice guidance updated Oct 2013 is available here:
http://www.healthcheck.nhs.uk/commissioners_and_healthcare_professionals/national_guidance/
Written NHS Health Check information should be provided to all, outlining the risks and benefits of the programme. Leaflets will be provided by B&NES Public Health.
The NHS Health Check must include a face to face assessment, including: CVD risk calculation and lifestyle review; and advice (approximately 20 – 30 mins).
The following tests, investigations and information must be completed as part of the NHS Health Check delivered outside of GP surgery:
· Blood pressure
· Smoking status
· Height and weight measured to enable Body Mass Index calculation
· Physical activity levels – measured using the GPPAQ https://www.gov.uk/government/publications/general-practice-physical-activity-questionnaire-gppaq
· Total Cholesterol/HDL ratio (random non fasting) – via a capillary blood test
· Family history of diabetes, premature heart disease
· Ethnicity
· Assessment of alcohol consumption for all patients – use the AUDIT-C questionnaire
· http://www.alcohollearningcentre.org.uk/Topics/Browse/BriefAdvice/?parent=4444&child=4898
· Cardiovascular Risk Score
· In addition, those aged 65-74 should be made aware of the signs and symptoms of dementia through the provision of the NHS Health Check Dementia leaflet and sign posted to memory services if this is appropriate.
Providers will calculate the 10 year cardiovascular risk score using an evidenced based tool(QRISK2) communicate risk and offer appropriate lifestyle advice.
Patients should receive the following:
· All patients should receive an explanation of their CVD risk.
· Those patients at high risk (≥ 20% risk) should receive appropriate interventions to reduce their risk of vascular disease via their GP surgery
· All patients who smoke, are overweight or inactive should be offered advice and/or referral to appropriate services for lifestyle interventions aimed at reducing vascular disease risk. This may be within a patient’s GP practice or elsewhere in the community (e.g. Smoking Cessation, physical activity, weight management programmes etc.)
· Patients who score 8 -19+ on AUDIT should be given brief advice on alcohol consumption. Those patients who score 20+ on AUDIT should be referred to their GP or the local drug and alcohol service for specialist advice and treatment.
· Everyone attending for an NHS Health Check should be provided with general lifestyle information and advice. This should be appropriate to the patients’ needs. All patients should receive a ‘NHS Health Check What Happens Next’ leaflet (provided to providers by Public Health).
· 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.
Patients with a lower CVD risk score (below 20%) will be recalled for assessment by their GP surgery after 5 years.
People who are found to be at or above 20% risk should exit the programme irrespective of whether they have signs of disease and should be placed on a high risk register and managed accordingly by their GP surgery. Where people have managed to reduce risk to below 20% through this process they should be removed from the register and recalled for assessment after 5 years.
COMMUNICATION OF RESULTS
The use of the QRISK2 risk engine to calculate the individuals’ risk of developing cardiovascular disease in the next ten years is required, and everyone who undergoes a NHS Health Check must have their cardiovascular risk score communicated to them. The person having their check should also be told their BMI, cholesterol level, blood pressure and AUDIT score.
In addition to recording this information on provider databases this information should also be recorded in the patient leaflet - ‘NHS Health Check What happens next.’ (provided by B&NES Council) and given to the patient to take away with them.
RISK MANAGEMENT, REFERRAL AND FOLLOW UP
Where the risk assessment is conducted outside the person’s GP practice, there is a legal duty for the above information to be forwarded to the person’s GP. Data must be transferred in a timely and secure method to the patient’s GP practice (legal requirement in the 2013 regulations)
http://www.legislation.gov.uk/uksi/2013/351/regulation/5/made
A timely referral back to the GP practice should be made following Information Governance and Data Protection Act guidelines, to ensure appropriate follow up is undertaken (see standard 10 of Programme Standards (Feb 2014)
All referrals to lifestyle services should be sent to Sirona Healthy Lifestyles Hub either through electronic data transfer, fax or by post.
Clients deemed high risk must be asked to make an appointment with their GP surgery and a referral letter/electronic data transfer should also be sent to the GPsurgery with the client’s test results. All test results must be sent to the clients GPsurgery.
All information collected during a health check for every client should be sent back to the GP surgery electronically, by fax or by post or via nhs.net
DATA AND MONITORING REQUIREMENTS
The provider will submit monitoring data and annual reporting on outcomes to B&NES Council for the purposes of generating payments and measuring effectiveness.
The provider will record patient information concerning invitation, risk assessment and risk management using the standardised data template, as supplied by B&NES Council.
The data received by the council will be activity data only for monitoring and reporting purposes and will be completely anonymised.
The data return will include all information as outlined in Schedule B.
QUALTITY ASSURANCE - WHAT NEEDS TO BE IN PLACE:
PROFESSIONAL COMPETENCY, EDUCATION AND TRAINING
· If required, pharmacy/outreach staff carrying out NHS Health Checks should be able to demonstrate their professional eligibility, competence and continuing professional development to the commissioner by producing relevant documentation.
· The provider must be able to demonstrate that all staff delivering the NHS Health Checks programme are competent in the following areas:
· Knowledge of the national and local NHS Health Checks programme
· Vascular disease risk assessment including the use of risk assessment tool (QRISK2)
· Risk communication
· The use of point of care testing
· Lifestyle management advice and onward referral
· Appropriate referral for clinical assessment and management.
Where necessary the Council will provide additional training to support staff in delivery but the provider is responsible to ensure staff are fully competent.
If additional training is scheduled, the provider is expected to allow at least one member of staff already delivering Health Checks to attend.
Update training and/or competency assessment may be undertaken on an annual basis or if changes to the programme occur.
For more information see: NHS Health Check: Competence Framework (June 2014)
http://www.healthcheck.nhs.uk/commissioners_and_healthcare_professionals/national_guidance/
All service providers will be expected to deliver the NHS Health Checks in keeping with the core structure and standards set out in the national guidance and comply with local clinical guidance see annex 2 ) and data transfer standards.
See NHS Health Checks: Programme Standards: A framework for quality improvement (Feb 2014) http://www.healthcheck.nhs.uk/commissioners_and_healthcare_professionals/national_guidance/
INFORMATION GOVERNANCE
The community pharmacy must comply with the Information Governance and Data Protection clauses under section B37 of the 2013/14 Public Health Services Contract.
· The pharmacy/outreach provider must maintain appropriate records to ensure effective ongoing service delivery and audit.
· The provider will record all relevant information using the recommended NHS Health Check data collection software.
· Records will be confidential and should be stored securely and for a length of time in line with local NHS record retention policies and the Data Protection Act.
· The provider will co-operate with any locally agreed assessment of service user experience and attend any future required accreditation training updates as appropriate.
· To ensure the security of confidential information the provider should be at least level 2 compliant with the IG Toolkit
See link to toolkit below
https://www.igt.hscic.gov.uk/
AUDIT
· Providers will actively participate in internal and external quality assurance processes including providing information for audit purposes and adhering to the Quality Assurance Framework including co-operating with premises visits as part of a planned programme of service improvement.
PATIENT, PUBLIC AND STAFF SAFETY
· Clinical guidelines should be followed when measuring height, weight, blood pressure, cholesterol and cardiovascular risk and referring people for additional testing.
· The pharmacy should have in place good risk management systems.
· Staff involved in delivering the NHS Health Check to have standard Disclosure and Barring Service (DBS) clearance (previously Criminal Record Bureau (CRB) clearance).
HEALTH PROTECTION MEASURES
The pharmacy/outreach should have in place appropriate health and safety, infection prevention and control procedures
The pharmacy/outreach contractor will nominate a named pharmacist/health care professional to act as the clinical lead for the service.
· The pharmacy/outreach contractor should ensure that their staff are made aware of the risk associated with the handling of clinical waste and the correct procedures to be used to minimise those risks.
· A needle stick injury and spillage procedure must be in place in line with B&NES Council guidance.
· Appropriate protective equipment, including gloves, aprons and materials to deal with blood spillages, must be readily available on the premises where the service is provided.
· It is the responsibility of the pharmacy/outreach contractor to ensure that pharmacists/health care professionals involved in the delivery of this service have been immunised against Hepatitis B (for those that have not been immunised, they must have an accelerated course for immunisation for Hepatitis B: first three doses given at 0, 7 and 21 days and the 4th dose is taken after 12 months)[1].
CHARGING
· The programme will be made free of charge to the client. If the service provider is found to be charging clients their contract will immediately be terminated and they will be removed from the programme. Similarly, if it is learnt that slimming or any other weight management/health products have been recommended as part of the NHS Health Check, it would result in termination of the contract.
PROFESSIONAL STANDARDS AND INDEMNITY
· The pharmacist/outreach must ensure that their professional indemnity insurance provider has confirmed that this activity will be included in their policy.