Around 14,000 NHS Health Checks take place in Newham each year. Newham Council commissions the borough’s GP federation to deliver them, which sub-contracts to GP practices. Along with some neighbouring boroughs, Newham benefits from excellent data through a partnership with the Clinical Effectiveness Group based at Queen Mary University of London.
The challenge and response
Newham Council commissions its GP federation, Newham Health Collaborative, to deliver NHS Health Checks. The federation sub-contracts to the borough’s 43 GP practices, all of which are signed up to the programme.
Along with the neighbouring boroughs of Tower Hamlets and Hackney, Newham benefits from gold-standard data through a unit called the Clinical Effectiveness Group (CEG), part of Queen Mary University of London (QMUL). This has evolved since the 1990s, when a group of doctors in Tower Hamlets decided to act collectively. Now, the CEG uses data-driven tools and research to improve population health in north-east London and beyond.
Kieran Scott, Newham’s Senior Commissioner for Public Health, said this enables an intelligence-led approach to understanding equity and health outcomes. “We commission the CEG to provide various functions, one of which is data. That means we get very regular data from all our GPs on NHS Health Checks. On top of the standard data requests, we can also ask for ‘deep dive’ data.”
The CEG searches GP practice lists and identifies eligible people, saving time for individual practices. Residents with the highest level of risk are invited first. Kieran Scott said: “This routine access to data has allowed us to set up regular performance monitoring with individual GPs and PCNs [primary care networks], which goes some way to explaining why Newham does well terms of the number of Health Checks completed. We also have excellent GPs who work incredibly hard and reflect the cultural diversity of our community – employing Newham residents that literally speak the language of those attending for a Health Check.”
Newham’s commissioners are now looking to improve how they routinely compare the eligible cohort to those who take up the offer. For example, looking at whether relatively few men, or fewer people of a certain ethnicity, come for a Health Check.
“That’s something we have done historically as a snapshot data request and we’ve found that NHS Health Check uptake is broadly equitable in Newham. But we need to have a data source built in to help us routinely monitor equity of uptake and of outcomes – i.e. are all residents being followed up appropriately when issues are identified? We have some data on this, but we want to expand it further along the care pathway. We are working on that with our ICB [integrated care board] colleagues.”
Mental health screening
Newham’s NHS Health Check includes mental health screening for anxiety and depression, using shortened versions of the PHQ9 and GAD-7 screening tools. If these indicate a problem then the longer versions are used, and there is a pathway into mental health services if required. The team track what proportion of these individuals get the right referrals.
The CEG uses its own data to generate invoices on behalf of GPs, which is popular as it saves time for the practices and is accurate. This enables Newham to have a payment model based on activity, completion and outcomes. There is a standard Health Check completion fee; extra payments associated with the mental health screening; and small bonus payments attached to making appropriate referrals. This payment model works well because of the level of trust between GPs, the GP federation and the council, built up over years.
Kieran Scott said: “Since we started contracting with the GP federation in 2018, our performance has improved. We pay GPs based on outputs and outcomes, so we have lots of layers built in to try to drive up performance.”
While much of Newham’s success with NHS Health Checks is down to the unique local circumstances, elements of it are transferable. “We do have this unique architecture through QMUL, but you could potentially make elements of it work in other places. It is all underpinned by a strong shared system.”
Looking ahead
With the Health Check programme working well here, there is little incentive to change the delivery model unless data showed a clear need. Outreach provision is not currently offered as GP practice provision suits this locality. However, Newham’s contract with the GP federation contains an optional ‘work package’ for NHS Health Checks outreach, in case a need is identified at a later stage.
While there could be a role for some form of digital pre-screening as part of the Health Check process, again there is little appetite to change the current model. Newham has a large proportion of residents who do not have English as a first language. There is concern that introducing a ‘digital front door’ to Health Checks could negatively impact some of these residents.
Contact:
For more information contact Kieran Scott, Senior Commissioner (Public Health): [email protected]