NHS Health Check (Vascular)

NHS Newham

NHS Health Check (Vascular)

(Formerly known as Vascular Risk Assessment)

Local Enhanced Service (effective from 1st November 2009) for pharmacies /dental practices

Contents:

1)Introduction

2)Service Aims and Needs Analysis

3)Components of the Local Enhanced Service

4)Duration and Scope of the Local Enhanced Service

5)Contractual Agreement

6)Signature sheet

1. Introduction

All PCTs are required to further develop their programmes of systematic vascular health checks from April 2009, for everyone aged 40-74 years. NHS London has identified this as one of its six corporate priorities for 2009/10 and produced London-wide guidance to support this work. The programme’s objective is to offer everyone in the target age group a vascular check at five yearly intervals. This is therefore a long-term project, and in due course patients’ data will be incorporated into a call-recall system to ensure patients are invited again as their next check becomes due.

Newham has high rates of heart disease mortality and a high prevalence of type 2 diabetes. Evidence shows that damage to the vascular system increases with age, and progresses faster in men than women, in those with a family history of vascular disease and in some ethnic groups. These are called ‘fixed factors’ because they can’t be changed. We know that we have many people in our population with fixed factors. However, the rate at which vascular damage progresses is also determined by ‘modifiable factors’, i.e. factors which can be altered. Changing these can greatly reduce the probability that vascular disease will strike early, bringing premature death or disability.

These modifiable factors are: smoking, physical inactivity and a sedentary lifestyle, high blood pressure, hyperlipidaemia, and obesity. The NHS Health Check (Vascular) aims to identify those factors and to help people change these modifiable factors before the damage is done, as well as identifying patients who need medical treatment.

2. Service Aims and Needs Analysis

The aims of the NHS Health Check (Vascular) programme are:

Personal risk measurement

Providing each patient with a written summary of their cardiovascular risk and the measures they should take to reduce it (general advice on staying healthy, advice and assistance, and specific interventions where appropriate for healthy diet, weight reduction, physical activity, and smoking cessation)

Medical management where indicated – primary prevention with statins, blood pressure control, treatment of impaired glucose regulation, management of ischaemic heart disease, stroke/TIA, etc which will be undertaken in the GP setting

In addition, the aims of the Pharmacy and Dental Health Check LES are

To provide NHS Health Checks in pharmacies and dental practices in Newham

To offer NHS Health Checks to people who are less likely to engage with traditional health services in traditional health settings

Needs Analysis

There are about 74600 people aged 40-74 in Newham. This means that on average about 14,900 individuals per annum should be offered the NHS Health Check (Vascular). The Department of Health estimates that approximately 8,100 of these would attend.

This means that, in an average-sized general practice in Newham, about 200 patients should be offered a check each year, and the practice will average three or four checks per week.

The proportion of patients whose provisional (“baseline”) risk of a cardiovascular event in the next 10 years is 20% or greater will vary from practice to practice, but is expected to be about a fifth of patients aged 40-74 in Newham (the national average is around 9.5%).

Provision for community based assessments will support opportunistic assessments for those residents who wish to access health checks through this route. It is envisaged that approximately 5 people will be seen per week in a pharmacy/ dental practice setting. Each participating pharmacy /dental practice has an indicative quarterly target of 60 NHS Health Checks. The carrying forward of under activity into the next quarter will not be permitted without the consent from the PCT. Contractors should ensure that no further checks are undertaken once they have reached this figure until they have been in contact with the Vascular Risk Programme Manager and they have been advised that they may continue with a new target figure. The practice will be monitored against their activity levels and the PCT reserves the right to withdraw the service and remove any equipment provided to support NHS Health Check provision should the contractor not meet the specified targets. The PCT will offer support in order for pharmacists/ dentists to meet their targets wherever possible and appropriate to do so.

3. Components of the LES

Payments under this NHS Health Check (Vascular) LES will be made to pharmacies/ dental practices who satisfy NHS Newham that their plans adequately cover the following five components:

1)Capacity and capability to carry out assessments, and opportunistic assessments when people attend for other reasons; ability to perform assessments to the necessary standard, with staff training where necessary (e.g. for pharmacy technicians, dental nurses etc) and quality control procedures for point-of-care testing. Health checks should be offered during all opening hours and not be restricted. This is in order to offer maximum choice to the residents of Newham.

2)Initial assessment for each patient, consisting of history, brief examination, and investigations including point-of-care testing (random blood glucose, non-fasting total cholesterol and HDL).

3)Calculation of 10 year-risk of cardiovascular disease (including risk stratification).

4)Planned data management. This recording the results for person seen at the pharmacy / dental practice using the PCT provided forms and sending the forms through to the PCT and the named Practice on a daily basis. Pharmacies / dental practices should review their data handling regularly (including training needs), support the introduction of EMIS web in their pharmacy/ dental practice when this becomes PCT policy, and provide anonymised data for audit (via the Clinical Effectiveness Group or, in future, another PCT-approved method such as EMIS web) using processes which have been agreed in consultation with the LPC/ LDC.

5)Structured health education should be offered to ALL persons attending for a vascular check. Pharmacies / dental practices should provide individuals with a written, individualised summary of their vascular risk status and the measures they should take to reduce risk (general advice on staying healthy, advice and assistance, and specific interventions where appropriate for healthy diet, weight reduction, physical activity, and smoking cessation). Individuals accessing the service should be offered information about local health improvement services and how to access them and appropriate and suitable health literature (leaflets such as those published by the British Heart Foundation, Blood Pressure Association etc). Pharmacies / dental practices should invite people to use services appropriate to their risk factors – details of available services will be circulated to pharmacies/ dental practices byNHS Newham.

Component 1: Capacity and capability to carry out assessments

Details

Please decide who will be the lead person for vascular risk in the pharmacy / dental practice, and give their name and contact details.
Please set out how the NHS Health Check (Vascular) will be delivered in your pharmacy/ dental practice, including capacity (consulting room space and clinician availability) to carry out assessments.Consultation areas should ensure privacy(which includes visual privacy) and have sufficient space and facilitates to support the provision of the service, which should also include offering a chaperone if appropriate to do so. A separate waiting area should be available.
Describe how people will be recruited and intended numbers per week.
Please give details of training for staff carrying out vascular checks. Pharmacies/ dental practices should review each staff member’sindividual educational needs at least annually, and ensure that each individual receives appropriate ongoing education and professional development. Before doing assessments staff should have had full training on data recording, standardised assessments, basic health education, and point-of-care testing equipment and procedures in line with national guidance.
Staff should achieve the required competencies, and this should be documented and available for inspection by NHS Newham.
Please set out quality control procedures for point-of-care testing.
Please confirm the following areas:
That appropriate indemnity cover is in place
That all staff will adhere to the quality standards and guidelines of their professional body
That all staff will adhere to the standard operating procedures including needle stick injuries and the handling and disposal of clinical waste( including spillages)
That all NHS infection control standards are complied with
That all staff undertaking point of care testing have been immunised against Hepatitis B
That all staff undertaking components of the NHS Health Check have undertaken the CRB check
That hand washing facilitates are available in the consultation room or close by
That a clinical waste service is available
That protective equipment including gloves is available at all times
That posters promoting the service will be displayed in the premises fascia and inside the pharmacy/ dental practice
That weekend and evening slots are available
Note that pharmacies/ dental practices are responsible for ordering consumables for their point of care testing equipment, maintaining the equipment in serviceable condition, disposing of clinical waste andorganising their quality control programme and the cost of these will be borne by the pharmacy/ dental practice. Quality control arrangements should conform to minimum NHS Newham’s standards.
Please ensure you cover all these items; feel free to continue on a separate page. Please attach a copy of this to your signature sheet.
* NHS Newham will continue to commission a range of courses covering topics such as smoking cessation, weight management, and lifestyle change. Training updates specific to Health Checks assessments will be offered twice a year.
* NHS Newham will provide guidance on the minimum competencies required for staff carrying out vascular checks, in line with forthcoming national standards.
* NHS Newham will meet the cost of internal quality control checks for each practice’s point-of-care equipment, currently approximately £90 per annum, where the system used is that initially supplied by NHS Newham.

Practice plans for year 2009/10

(please detail below your pharmacy/ dental practice plans)

Practice evaluation at end of year / results

(at the end of the year please detail below the practice’s results for this criteria)

Component 2: Initial assessment

Assessment

Please confirm how your pharmacy /dental practice will carry out a NHS Health Check (Vascular)
Please confirm that you agree to check the eligibility criteria check list with the person before undertaking the NHS Health Check.

The person should not have undertaken a Vascular risk Assessment/ NHS Health Check within the last five years
The person should be between the ages of 40-74
The person should not have had their cholesterol checked within the last year
The person should not have hypertension, not be diagnosed with having CHD/ CVD/, should not have had a stroke or have kidney disease
The person should give signed consent to having a NHS Health Check
The person should give signed consent ( on the PCT form) to share their data with their GP in order to inform the practice of their check results and for the pharmacists / dentists to contact the GP for purposes of follow up
The person should give signed consent to send their data to the PCT until a IT system has been developed which facilitates seamless data transfer electronically

All unregistered patients should be signposted to the ‘Find a Doc’ service or the Transitional Care Practices where they can register without providing any specific documentation
This service is for residents who live in Newham. However you are not required to ask for proof of address and payment will follow for those assessments undertaken in good faith. All assessment forms should be sent through to the individuals’ GP or through to the safe haven fax for those who do not have a GP

Details

Initial assessment for each person consists of history, brief examination, and point-of-care testing (random blood glucose, non-fasting total cholesterol and HDL).
History
age and gender
ethnicity
family history (first degree relatives with diabetes) (for CHD, record age at onset – positive family history is younger than 55 in fathers, sons or brothers or younger than 65 in mothers, daughters or sisters)
history of gestational diabetes
medication already prescribed (statins, ACEI or ARB, beta-blocker, aspirin or warfarin)
Lifestyle
smoking status
current physical activity level
Measurements
height
weight
body mass index (BMI)
waist circumference
blood pressure
blood glucose, non fasting total cholesterol and HDL (measured by point-of-care testing on a finger prick blood sample)
The audit of this service will be based on the codes used in the approved NHS Newham template. Use of this template to record NHS Health Check (Vascular) data is mandatory. Payments will be made for each patient recorded as having a full initial assessment at the pharmacy/ dental practice.

Practice Plans for Year 2009/10

(please detail below your pharmacy/ dental practice plans for this criterion)

PracticeEvaluation at end of Year / results

(at the end of the year please detail below the pharmacy’s/ dental practice results for this criteria)

Component 3: Calculation of 10 year risk of cardiovascular disease

Please confirm that the pharmacy / dental practice will use its NHS Health Check risk assessments to identify people at higher risk of developing CVD, by means of their QRISK2 score.
Please set out details of how pharmacy / dental practice staff will learn about QRISK2, and the steps already taken to understand its potential.

PracticePlans for Year 2009/10

(please detail below your pharmacy’s/ dental practice plans for this criteria)

Practice Evaluation at end of Year / results

(at the end of the year please detail below the pharmacy’s / dental practice results for this criteria)

Component 4: Planned data management

Please outline your approach to the following points:
The pharmacy/ dental practice should set out its policy for referring people who require it, as a result of a Health Check i.e. sending patients to the GP for further assessments i.e. fasting lipids and HbA1C etc
Please confirm the pharmacy / dental practice will use NHS Newham’s approved data template (currently the template designed by the CEG) for recording the outcomes of the Health Check
Pharmacies / dental practices should set out their plans for recording and/or auditing the clinical outcome of their Health Check risk assessments (e.g. patients requiring further investigations
Please confirm that the pharmacy / dental practices will provide patient data for audit purposes, via the Clinical Effectiveness Group or other organisation approved by NHS Newham for data governance purposes. The pharmacy’s / dental practice statement should include an agreement to implement EMIS web or an alternative data sharing programme if adopted as PCT policy (with appropriate technical support)
Ideally there should be IT systems with the consultation room with access to the intranet, potentially able to runadditional software and capable of using NHSmail.
All participating pharmacists/ dentists should have NHS net email accounts
All records are to be treated as confidential and must be stored in a secure area, under lock and key. Access to these records isfor approved staff only. All records should the management of the records should comply with the data Protection Act 1998
All assessment forms should be faxed through to the individuals’ GP on the day of assessment via a safe haven fax and contractors are required to check that the fax has arrived

Practice Plans for Year 2009/10

(please detail below your pharmacy’s / dental practice plans for this criteria)

Practice Evaluation at end of Year / results

(at the end of the year please detail below the pharmacy’s/ dental practice results for this criteria)

Component 5: Structured health education

Please set out the pharmacy’s/ dental practice plans to ensure ALL individuals attending for NHS Health Check (Vascular) will receive structured health education. Each person should receive a written, individualised summary of their vascular risk status and the measures they should take to reduce risk (general advice on staying healthy, advice and assistance, and specific interventions where appropriate for healthy diet, weight reduction, physical activity, and smoking cessation). A copy of each individual assessment form (and not the risk summary form) should be faxed to NHS Newham through the safe haven fax.

Pharmacies/ dental practices should provide information about local health improvement services and how to access them, and invite people to use services appropriate to their risk factors – details of the available services will be provided to pharmacies/ dental practices by NHS Newham. Pharmacies/ dental practices should provide a range of educational material for all individuals- leaflets, DVDs ect.

Assessment of patients’ cardiovascular risk and risk feedback should be done by a pharmacist,dentist,pharmacy technician or dental nurse with suitable training and experience who meet the PCT and /or nationally specified competencies.Please state which members of the pharmacy / dental team will be involved in assessing patients’ cardiovascular risk, and give brief details of their professional experience/qualifications.

NHS Newham will circulate details of local health improvement services, including those run by the London Borough of Newham, the voluntary sector, NHS Newham, and other providers.
Information will also be provided about other sources of health-related information such as good quality health websites, contact details for community groups, how to access self-help organisations, etc.
NHS Newham reserves the right to request an audit of anonymised written, individualised risk summaries in selected practices.

Practice Plans for Year 2009/10