NHS Health Check Training

Lauren Seamons – Norfolk LPCOctober/November 2015

What is an NHS Health Check?

Cardiovascular Risk

What is an NHS Health Check?

Norfolk Fire and rescue service video

Norfolk County Council Health Check Video

Why have an NHS Health Check? Video

Can I offer NHS Health Checks?

• Consultation room• Clinical Waste disposal• Equipment - CardioChek or LDX

- Scales (Class 3)- Height Chart- Tape measure- BP Monitor (BHS approved)

• Staff (www.bhsoc.org/bp-monitors/bp-monitors)

• IT availability• Contract• SOP

Recruiting patients NHS Health Checks

• Counter Staff• Letter from GP• Links to/from other services• Eligibility• Do you have a booking system?

Eligibility• Patient MUST: be aged 40-74 years old

reside and/or registered in Norfolk

• Patient must not have been diagnosed with:Coronary heart disease Chronic kidney disease (CKD)Diabetes HypertensionAtrial fibrillation Trans ischaemic attack (TIA)Hypercholesterolaemia Heart failurePeripheral disease Stroke

or be taking a statin

• Patients may access the service ONCE every 5 years

Eligibility

Available from the Health Information Leaflet Service now accessible via the Norfolk’s Living Well website

Performing an NHS Health Check

Explain what will happenPatient DetailsConsentHeight Weight and BMI calculationBlood pressureDiabetic Risk Risk ScoreCholesterol measurementLifestyle

Blood Pressure• Use correct cuff size

• Advise patient to sit comfortably with feet flat on the floor (no crossed legs)

• Breathe normally

• Keep arm relaxed

• Repeat if >140/90

• Repeat a third time towards the end of the check if still >140/90

Body Mass Index

BMI =

Calculator on PharmOutcomes

Alternative template for discussion

Waist Measurement (optional)

BMI classification Waist circumference Low High Very highOverweight (25-29.9) No increased risk Increased risk High riskObesity 1 (30 – 34.9) Increased risk High risk Very high risk Men: Low = less than 94cm, High = 94-102cm, Very high = more than 102cmWomen: Low – less than 80cm, High = 80 – 88cm, Very high = more than 88cm

• For individuals with a BMI between 25 - 35

• Measure from the side

• The tape measure should be snug but not indent the skin.

Physical ActivityCalculator on PharmOutcomes

Alternative template for discussion

AUDIT -C

http://www.alcohollearningcentre.org.uk/eLearning/IBA/platforms/ALC/ then click Pharmacy E-Learning

0 – 7 Lower risk8 – 15 Increasing risk16 – 19 Higher risk20+ Possible dependence

Dementia

http://www.healthcheck.nhs.uk/increasing-dementia-awareness-training-resource/

Communicating Risk

Who will communicate the risk score?

Be clear when a GP referral is necessary

Encourage the patient to choose their own changes

Get the balance right

Support Materials

Health Information Leaflet Service

Making ReferralsReason forappointment

Threshold Action Time

High CVD risk ≥ 20% Referral to practice nurse or GP for cardiovascular risk assessment

Within 2 weeks

Blood pressure 140 to 159 systolicand / or90 to 110 diastolic

Referral to practice nurse or GP for Hypertension risk assessment and Chronic kidney disease risk assessment.

Within 2 weeks

160 to 179 systolicand / or> 110 diastolic

Within 1 week

≥ 180 systolic Urgent referral to GP for Hypertension risk assessment, Chronic kidney disease risk assessment and other CVD risk management.

Same Day

FPG ≥ 7mmol/l Repeat FPG, intensive lifestyle advice or Referral to practice nurse or GP for diabetes risk management.

Within 1 week

HbA1c ≥ 6.5%/48mmol/l Repeat HbA1c, intensive lifestyle advice and Referral to practice nurse or GP for diabetes risk management.

Within 1 week

Total cholesterol > 7.5 mmol/l Referral to practice nurse or GP to assess possible familial hypercholesterolemia

Within 2 weeks

Weightmanagement

BMI ≥ 35 Referral to practice nurse or GP for weight management.

Within 2 weeks

Making Referrals