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NHS Health Check programme: supporting information

This document provides guidance on the statistical publication NHS Health Check programme, Patients Recorded as Attending and Not Attending, 2012-13 to 2017-18. The document includes details of what is and is not included in the figures and what the publication can and cannot tell you.

1. Experimental statistics

This publication is released as experimental statistics.

Experimental statistics are a series of statistics that are in the testing phase and not yet fully developed for several reasons such as:

  • Poor coverage
  • Poor data quality
  • Data undergoing evaluation

This publication is classified as experimental statistics for the following reasons.

Methodology used for reporting the collected NHS Health Check data are still in the process of being developed and subject to modification.

Not all patients with recorded NHS Health Check activity were extracted as part of the data collection for this publication. Complexities with the data extraction affected patients aged 69 years and over. As such, data in some age ranges is suppressed from all reporting in this publication.

Users should be aware of the status and constraints of this data. The limitations of each measure are explained in the Data quality section below.

2. Introduction

NHS Digital publishes this information to support the monitoring and delivery of the NHS Health Check programme. The aim of this publication is to inform users, ranging from providers and commissioners of primary care services to inquiring citizens about recorded activity for patients within the NHS Health Check programme.

NHS Digital acting on behalf of Public Health England have collected NHS Health Check data that has been recorded by use of a clinical code in a patient’s electronic record within their registered GP practice.

This publication is the initial release from a collaborative project between NHS Digital and Public Health England and focusses on patients attending and not attending an NHS Health Check between April 2012 and March 2018. Future publications reporting more detail of the collected data are planned and will be released by Public Health England.

No identifiable patient data is released as part of this publication. Data from individual GP practices cannot be identified from this publication.

3. The NHS Health Check programme

The NHS Health Check is a cardiovascular disease prevention programme delivered across England. It aims to improve the health and wellbeing of adults aged 40-74 years through earlier awareness, assessment and management of the major risks factors and conditions driving premature death, disability and health inequalities in England. In doing so it will help to prevent heart disease, stroke, diabetes and kidney disease. The programme will also raise awareness of dementia both across the population and within high risk and vulnerable groups. Since 2013 this nationally led programme has been delivered by local authorities who are responsible for offering an NHS Health Check every five years to all eligible adults.

4. What this publication can tell you

The number of patients attending or not attending an NHS Health Check in financial years between 2012-13 and 2017-18, using activity recorded by clinical codes from participating GP practices in England.

Geographic breakdown of this activity is provided by:

  • Local authority based on the area of residence of a patient
  • Clinical Commissioning Group (CCG) based on the registered GP practice of a patient

Counts of activity give details of the sex, age banding and recorded ethnicity of patients.

The percentage of recorded patients attending an NHS Health Check as a proportion of those recorded as either attending or not attending.

At a national level, counts of activity identifying the type of non-attendance of an NHS Health Check, for example ‘declined to attend’.

5. What this publication cannot tell you

NHS Health Check recorded activity prior to April 2012 is not reported in this publication. Although the NHS Health Check programme was first piloted in 2009, it was not fully rolled-out across England until 2012-13.

No estimates for the population eligible for an NHS Health Check are provided in this publication.

No activity is reported in the publication for patients with a calculated age outside of the 40 -74 age range at the point of their NHS Health Check activity. See section 7.4 for suppressions applied to the age of reported patients.

The following activity is not reported as part of this publication but may be reported as part of future publications:

  • the number of times a patient was recorded as invited before attending an NHS Health Check
  • details of tests, advice or interventions given as a result of patients attending an NHS Health Check
  • data collected about patient outcomes as a result of attending or not attending an NHS Health Check
  • where the NHS Health Check was performed or by whom, for example a third party
  • the format of an invitation sent to attend an NHS Health Check, such as a letter

6. Data extraction

The recorded NHS Health Check activity reported in the publication was automatically extracted from participating open and active GP practices in England using the General Practice Extraction Service (GPES) run by NHS Digital.

Data was extracted from GP practices using system suppliers EMIS, Microtest, TPP and Vision between June 2018 and June 2019.

Recorded NHS Health Check activity that took place before 1st April 2018 was extracted.

Activity for patients recorded as not consenting to their data being released outside of their GP practice for purposes other than direct patient care, was not extracted.

Activity for patients recorded as having left a GP practice before the date of extraction was not extracted.

7. Data quality

There are no national standards for the data entry of NHS Health Check activity and variation exists across GP practices and system suppliers. Suppression of reported activity is also applied due to incomplete NHS Health Check activity being extracted in certain age bands.

The main known data quality issues are recorded below:

7.1 Recording of activity

There is no unique standard template for recording NHS Health Check activity.

In this publication, NHS Health Check activity refers to any interaction that a patient may have had with the NHS Health Check programme. This includes if a patient was invited to, commenced, completed, declined, did not attend, or was inappropriate for, the NHS Health Check.

Data extracted and reported in this publication covers NHS Health Check activity that has been recorded by use of a clinical code in a patient’s electronic record within their registered GP practice.

The following NHS Health Check activity is not included in the publication:

  • NHS Health Check activity that has not been recorded by use of a clinical code
  • NHS Health Check activity recorded by a clinical code not included in the business rules documentation
  • NHS Health Check activity recorded in GP practices where data was not extracted

Only NHS Health Check activity undertaken by third party providers that has been retrospectively coded for a patient within their registered GP practice system is included in reporting.

7.2 GP practice participation

Open and active GP practices at the time of their system supplier’s extraction were invited to participate in the project. NHS Health Check recorded activity was extracted from 90% of GP practices in England that were open and active at 31st March 2018.

GP practice participation varies across regions and full details can be found on the Data Coverage tab within the Summary tables file.

7.3 Geographic reporting

Activity in the publication is reported by two different geographic breakdowns:

  • Activity based on the area of residence of a patient is reported at local authority level
  • Activity based on the registered GP practice of a patient is reported at CCG level

In the local authority breakdown, activity for the following local authorities is reported together:

  • Hackney and City of London
  • Cornwall and Isles of Scilly

Where the area of residence of a patient is not in England, unknown or not recorded, activity is reported as ‘Not assigned’.

In the CCG level breakdown, activity from GP practices is mapped based on financial year 2019-20 area configurations.

Where more than one GP practice has reported the same patient as currently registered, activity is reported as ‘Not assigned’.

7.4 Age

An approximation of the patient’s age at the point of their NHS Health Check activity is calculated based on the patient’s year of birth.

For example, a patient with a year of birth of 1961 receiving an NHS Health Check in 2015 is calculated as 54 and reported in the 50-54 age band.

Not all patients aged 69 and over with NHS Health Check activity have been extracted, due to complexities with the extraction process. The following reporting suppressions have been made and apply to all reported figures in the publication:

  • patients with a calculated age of 69 and older at the time of their NHS Health Check activity have been suppressed from the figures in financial year 2012-13
  • patients with a calculated age of 70 and older at the time of their NHS Health Check activity have been suppressed from the figures in financial years 2013-14 onwards

The NHS Health Check programme is targeted at eligible patients between 40 and 74 years of age. Recorded NHS Health Check activity for patients outside of this age range at the time of their activity, is excluded from this publication.

7.5 Ethnicity

Variation in how ethnicity of patients is recorded exist across GP practices and system suppliers.

The latest recorded ethnicity code of a patient has been used for reporting where this is available. This code has been mapped to the reported ethnic category.

The mapping used from the coded ethnicity to the reported ethnic category is detailed below

Ethnicity coded Reported ethnic category
Arab Any other ethnic group
Any other ethnic group Any other ethnic group
Bangladeshi Asian or Asian British
Chinese Asian or Asian British
Indian Asian or Asian British
Pakistani Asian or Asian British
Any other Asian background Asian or Asian British
African Black or African or Caribbean or Black British
Caribbean Black or African or Caribbean or Black British
Any other Black background Black or African or Caribbean or Black British
White and Asian Mixed or multiple ethnic groups
White and Black African Mixed or multiple ethnic groups
White and Black Caribbean Mixed or multiple ethnic groups
Any other mixed background Mixed or multiple ethnic groups
British White
Gypsy or Irish Traveller White
Irish White
Any other White background White
Not stated Ethnicity not stated or recorded
Unknown/No information Ethnicity not stated or recorded

Where the latest ethnicity for a patient has been recorded using two different codes which when mapped cover different ethnic categories, the ethnic category is reported as ‘Ethnicity not stated or recorded’

Ethnicity is typically recorded as part of a completed NHS Health Check. Patients attending an NHS Health Check are more likely to have this information recorded than those not attending.

8. Methodology

Patients included in the data extract may have a single or multiple recorded interaction with the NHS Health Check programme. The process below explains how these recorded interactions are used to report a patient as attending or not attending an NHS Health Check in a financial year.

8.1 Categories

Each patient with NHS Health Check activity recorded within a financial year is counted in one of six categories for that financial year.

Patients are assigned to the first applicable category:

# Category Reported grouping Criteria
1 Inappropriate Excluded from all reporting Patient has a code recorded as being inappropriate for an NHS Health Check in any financial year
2 Completed Attending Patient has a completed NHS Health Check code recorded in the financial year
3 Declined Not attending Patient has a declined NHS Health Check code recorded in the financial year
4 Did not attend Not attending Patient has a did not attend NHS Health Check code recorded in the financial year
5 Commenced Not attending Patient has a commenced NHS Health Check code recorded in the financial year (and no complete/did not attend/declined code recorded in the following 8 weeks) *
6 No response Not attending Patient has an invitation to attend an NHS Health Check code recorded in the financial year (and no complete/did not attend/declined/commenced code recorded in the following 6 months) **

Where patients are assigned to category 5 or 6 the following updates are made to ensure activity that took place at the end of a financial year is accurately represented:

* Patients recorded with a completed, declined or did not attend NHS Health Check code within 8 weeks of a recorded commenced NHS Health Check code in the previous financial year will only be counted in the year of the completed, declined or did not attend code. Patients will not in addition be counted as not attending in the year of the commenced code.

**Patients recorded with a completed, declined, did not attend or commenced NHS Health Check code within 6 months of a recorded invitation code in the previous financial year will only be counted in the year of the completed, declined, did not attend or commenced code. Patients will not in addition be counted as not attending in the year of the invitation code.

Where any patient has an NHS Health Check activity code recorded more than once in the same category within a financial year (for instance multiple invites), only the earliest occurrence in that year is used.

8.2 Timing

The publication reports recorded NHS Health Check activity from 1st April 2012 until 31st March 2018.

As attendance outcome data for the period after 31st March 2018 was not part of the data collected, the actual:

  • number of patients not attending an NHS Health Check in financial year 2017-18 will be lower than reported in the publication
  • percentage of patients attending an NHS Health Check in financial year 2017-18 will be higher than reported in the publication

8.3 Multiple NHS Health Check events

The NHS Health Check programme invites eligible patients to attend an NHS Health Check every five years.

In this publication, patients recorded as receiving NHS Health Check activity in more than one financial year are counted in multiple years, subject to the methodology in section 8.1.

9. Publication outputs

Details of the outputs produced as part of this publication are described below.

9.1 Summary tables

A set of summary tables are released with this publication in a file called NHS Health Check programme, Patients Recorded as Attending and Not Attending, 2012-13 to 2017-18: Summary tables

The file includes:

  • Data Coverage, count of GP practices included in the publication by region
  • Table 1, Patients NHS Health Check attendance status, England
  • Table 2a, NHS Health Check patients attending, sex, age-band, ethnicity, England
  • Table 2b, NHS Health Check patient not attending, sex, age-band, ethnicity, England
  • Table 2c, Percentage of patients attending as NHS Health Check as a proportion of those recorded as either attending or not attending, sex, age-band, England *
  • Table 3, Patients NHS Health Check attendance status, NHS regional level, based on the registered GP practice of patients
  • Table 4, Patients NHS Health Check attendance status, local authority level, based on the area of residence of patients

*a percentage value has not been calculated for the ethnic categories due to the low recording of ethnicity for patients not attending an NHS Health Check meaning this value could be misleading.

9.2 Csv data files

Four csv data files are released with this publication. Each of the two geographic breakdowns has two files with associated activity. The files contain the most detailed geographic breakdown of activity published.

The first file type reports aggregated counts of attendance status together with the sex and age band of patients.

The second file type reports aggregated counts of attendance status with the recorded ethnicity of patients.

Where numbers less than five exist in ethnic categories, these are reported together with the “Ethnicity not stated or recorded” category as “Ethnicity not stated or recorded and ethnicities with a small number”.

9.3 Dashboard

A dashboard is released with this publication which allows users to interactively explore the reported data.

The dashboard allows users to easily see counts of reported activity for a selected area. Activity can be viewed separately by the two different geographic breakdowns as well as the sex, age banding and recorded ethnicity of patients.

9.4 Document - A guide to published activity

Since 2013 data on the NHS Health Check programme has been reported by local authorities and published by Public Health England as indicators in the Public Health Outcomes Framework. This document puts in context the methodologies and processes involved in the local authority reported data in relation to the data reported through the GPES extraction.

Further information

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    Publication feedback

    NHS Digital are continuously seeking feedback on experimental statistics to help further development which can be provided by the above link.

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Last edited: 16 October 2019 2:41 pm