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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.
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.
The initial publication was released in October 2019 as a collaborative project between NHS Digital and Public Health England and focussed on patients attending and not attending an NHS Health Check between April 2012 and March 2018. In November 2020, further information was provided for the same groups of patients, including socio-economic characteristics and risk factors recorded in patients attending an NHS Health Check.
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 also raises 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.
[November 2020 update]
Counts of activity presented by national deprivation decile.
Counts of activity presented by within area (local authority) deprivation quintile.
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’.
[November 2020 update]
The percentage of patients attending an NHS Health Check who were found to be at low or increased risk of cardiovascular disease (CVD) and the percentage of attendees for which risk was not recorded.
The percentage of patients attending a Health Check with a recorded CVD risk factor in their GP records and the percentage of attendees for which risk factors were not recorded. The risk factors presented in this publication are alcohol consumption, smoking status, level of physical activity, body mass index, blood pressure, level of cholesterol, risk of CVD over the next 10 years (QRISK score), possible diabetes, family history of CVD.
5. What this publication cannot tell you
NHS Health Check recorded activity prior to April 2012 or after March 2018 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
- the risk factor profile of patients not 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’.
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.
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|
|Gypsy or Irish Traveller||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.
7.6 Index of Multiple Deprivation [November 2020 update]
This publication presents the proportion of attendances by national Index of Multiple Deprivation (IMD) deciles and, for local authorities, by area-specific IMD quintiles. Area-specific means that there is an equal proportion (roughly 20%) of the population in each quintile, whereas areas will often have an uneven distribution of the population across national IMD deciles.
National deprivation categories (IMD 2015 England decile)
Deprivation categories were assigned using IMD 2015. IMD 2015 national deciles were matched at Lower Super Output Area (LSOA) level based on the patient’s postcode of residence at the time of data extraction.
Within local authority deprivation categories (IMD 2015 within-area quintile)
LSOAs were grouped into separate deprivation classifications for each Upper Tier Local Authority (UTLA). IMD 2015 UTLA quintiles were matched at LSOA level based on the patient’s postcode of residence at the time of data extraction.
For counts of activity by deprivation quintiles within area, this publication does not include results for the following UTLAs because IMD 2015 is based on 2013 administrative boundaries:
- Bournemouth, Christchurch and Poole
- Combined Hackney-City
- Combined Cornwall-Scilly
To avoid potential disclosure all counts are rounded up to the nearest 5. Counts of zero remain as zero.
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.
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:
|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.
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.
8.4 Risk factors [November 2020 update]
For each patient attending an NHS Health Check, the date of attendance in the financial year was taken as the index date. This index date was used to identify the most relevant risk factor measurements for each attendee. Not all risk factor and clinical measurements were recorded on this index date. Therefore the risk factor and clinical measurements from other dates have been used in some cases. Risk factor and clinical measurements were selected for analysis if they occurred on the index date; but if no information was recorded on the index date, the information recorded up to 365 days before the check was used as the 2nd priority or up to 90 days after the check as the 3rd priority. For family history of CVD, the order for the priority for analysis is; if they occurred on the index date (priority); if no information was recorded on the index date the information recorded before the check (2nd priority) or after the check (3rd priority) was selected. A full list of clinical codes (Read v2 and CTV3) used to define each risk factor and the range for plausible values are published here.
For most risk factors (alcohol use, smoking status, physical activity, blood pressure, cholesterol, possible diabetes) attendees were categorised as either being at high risk, not being at high risk or as having missing information.
For body mass index (BMI), attendees were categorised as either being obese, being overweight, being not overweight or as having missing information.
For CVD risk in the next 10 years, attendees were categorised in 4 categories: score of 20 per cent or more (high risk of developing CVD), score between 10 and 19 per cent, score below 10 per cent (low risk) or as having missing information.
For family history of CVD, attendees were categorised as either being at risk or not being at risk.
|Risk factor||Source of information||Risk threshold cut point|
|Alcohol use||Score from FAST and/or AUGIT and/or AUDIT-C test||Higher risk is full AUGIT score 8 or more|
|Smoking status||Clinical code for smoking status||High risk if current smoker|
|Physical activity||Recorded score from GPPAQ test||Higher risk if “moderately inactive” or “inactive”|
|Body mass index||Recorded BMI value. Calculated BMI if BMI not recorded but values for height and weight available||
Overweight if BMI ≥ 25 and <30kg/m2
Obese if BMI ≥ 30kg/m2
|Blood pressure||Systolic and diastolic blood pressure recordings||Higher risk if systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg|
|Cholesterol level||Value of total cholesterol and value of cholesterol ratio. Ratio= total choleste||Higher risk if total cholesterol >5mmol/L or Ratio > 4|
|CVD risk score||QRISK / QRISK2 score or Framingham score if QRISK and QRISK2 unavailable||Higher risk if risk of CVD event in the next 10 years is 20% or more|
|Possible diabetes||Value of HbA1c or of Fasting Plasma Glucose (FPG)||Higher risk if HbA1C ≥ 48 mmol/mol or FPG ≥ 7|
|Family history of CVD||Clinical code recorded at any point||Higher risk if CVD event before 60 years old in a first degree relative|
To avoid potential disclosure all counts are rounded up to the nearest 5. Counts of zero remain as zero.
AUDIT: Alcohol use disorders identification test
BMI: Body mass index
CVD: Cardiovascular disease
FAST: Fast alcohol screening test
FPG: Fasting Plasma Glucose
GPPAQ: General practice physical activity questionnaire
HbA1c: Haemoglobin A1c
HDL: High-density lipoproteins
IMD: Index of Multiple Deprivation
LSOA: Lower Super Output Area
UTLA: Upper Tier Local Authority
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, IMD national decile,, England
- Table 2b, NHS Health Check patient not attending, sex, age-band, ethnicity, IMD national decile, 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 were released with the October 2019 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”.
Four additional csv files were published with the November 2020 update. Each of the two geographic breakdowns has two files with associated activity.
The first file type reports aggregated counts of attendance status together with the Index of Multiple Deprivation ranking of patients.
The second file type reports aggregated counts of level of CVD risks together with sex and age band of patients attending an NHS Health Check.
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 and financial year. Activity can be viewed separately by the two different geographic breakdowns as well as the sex, age banding and recorded ethnicity of patients.
[November 2020 Update]
The November 2020 update adds further pages to the dashboard to reflect the additional IMD and CVD risk breakdowns. Per geographic breakdown (LA and CCG), 4 new pages have been created to show:
- IMD ranking of patients who attended and did not attend an NHS health check
- Alcohol, physical activity and smoking risk of patients who attended an NHS health check
- BMI, blood pressure and cholesterol risk of patients who attended an NHS health check
- Diabetes, CVD risk and family history of CVD risk of patients who attended an NHS health check
These new pages allow users to easily see counts of reported activity for a selected area, financial year, age banding and sex.
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.
Direction given by Public Health England requiring NHS Digital to establish and operate a system for the collection and analysis of data on the NHS Health Check programme.
Information about the collection of NHS Health Check data from general practice.
Activity published by Public Health England on NHS Health Checks offered and received in local authority areas in England.
Information on the NHS Health Check programme.
Frequently asked questions about experimental statistics.
Further information about experimental statistics.
NHS Digital are continuously seeking feedback on experimental statistics to help further development which can be provided by the above link.