Primary Care IT strongly recommends that this article is understood before the searches are used in your Practice.

The searches have also been designed to ignore data captured at a previous surgery; for instance if a patient received an NHS Health Check at their previous GP at the beginning of the previous quarter and subsequently re-registered at this Practice, the data transferred via GP2GP does not count towards this Practice's activity claim.

Always check and act on the Data Quality folder before working through the reports. This is to ensure that data is as accurate as possible.

If any changes are made to a medical record, the folder must be re-run to update the reports. Read the next section carefully to understand what to expect in the data quality searches.

Running the NHS Health Check Reporting folder

1. Right click on the folder 030 NHS Health Check Reporting and select Run. If you are planning to report on the last completed quarter run it normally, while if you want to look at progress in the current quarter, choose a relative run date of the 1st day of the next quarter
   
2. Go to the NHS Health Check Data Quality folder and review NHC-201) Core Health check data MISSING report
   
1. Check the NHS Health Check column to confirm that health checks have been added by staff who are likely to carry out a health check. Educate admin staff and doctors about the use of NHS Health Check codes
   
2. Identify and address gaps in the core elements where NHS Health Check completed has been coded
   
3. Advocate changing the codes used (eg: NHS Health Check done by pharmacist, or Cardiovascular disease risk assessment done) so they aren't picked up
   
4. Re-run entire 030 NHS Health Check Reporting folder
5. View each report to view breakdown and enter on claim form (if applicable)
   

NHS Health Check Data Quality

The Data Quality folder currently has 8 searches and reports, the most important of which is Core Health check data MISSING.

Core Health check data MISSING

This report picks up patients who have been coded as having received an NHS Health Check but there are one or more data points missing from:

1. Ethnic origin
   
2. Smoking status
   
3. Blood pressure
   
4. BMI
   
5. GPPAQ activity score
   
6. Alcohol consumption
   
7. Cholesterol level
   
8. QRISK score
   

Each element is specified in the Best Practice guidance for NHS Health Checks. View Results on the report to identify gaps - hopefully there may be only one or two to complete. If a coded entry is visible in the care record but does not appear in the report, submit a ticket to PCIT technical support.

If there are more gaps than data entry points, consider that an NHS Health Check has not been undertaken. Consider identifying the user who added the NHS health check code and discuss its appropriate use; ideally the code would be deleted as entered in error.

Likely NHS Health Check not coded

At least 6 of the data points have been recorded but there is no code to document NHS Health Check completed. Add the code to include the patients data in the main reports.

Invalid NHS Health check programme codes last quarter

While there is currently no published SNOMED codeset for NHS Health Checks, a number of EMIS codes are available to use with terms relating to NHS Health Checks.

Patients appearing in this search have EMIS codes with no national SNOMED equivalent.

This search also identifies patients who were too old or too young when they were recorded as having an NHS Health Check.

Invalid BMI

BMI values recorded can sometimes be incorrect due to one of the height or weight values being in the wrong units (eg: height in metres instead of centimetres). Patients appearing in this search had a BMI recorded in the last quarter which is less than 10 or more than 200 (or a BMI with no value).

Invalid cardiovascular disease risk assessment

The latest NHS Health Check specification calls for the QRISK3 cardiovascular risk assessment tool to be used. Patients appearing in this search have had a QRISK, QRISK2, Framingham, or JBS cardiovascular risk score (or a QRISK3 without a score) in the last quarter.

Cholesterol missing a value

Cholesterol is a core component of the NHS Health Check. Patients appearing in this search have a cholesterol code (total or HDL) but it lacks a value. Review the record and update as appropriate.

NHS Health Check reporting

These reports have been compiled using the requirements of a number of different regions. If your region demands additional data points, please submit a support ticket with the requirements.

Each of the NHC-102 reports breaks down the numbers for the specified data point. Highlight each report in turn and press View Results on the ribbon (or right click and select View Results).

The aggregate reports will provide a set of numbers relating to the typical variables expected. In some reports it may be necessary to review the variables and group them together according to the local reporting requirements. Ethnic origin and smoking status are expected to generate the most variability. The reports are built in such a way that they are capable of being run retrospectively for previous quarters, including diagnosis of diabetes and hypertension.

NHSHC advice & signposting breakdown

This particular report needs some careful attention. During final testing it was found that some numbers reported in this search exceeded sensible levels, for instance every single patient being coded as offered smoking cessation advice is wrong - this is often down to the staff completing the NHS Health Check. A common sense approach is recommended to reporting, for instance if there are 20 patients with a check, 20 coded with smoking cessation advice, but only 5 recorded as current smokers, submit '5' for the number of smoking cessation advices given.

NHSHC referrals breakdown

Due to the number of codes involved, counting of different code terms listed for the same type of referral will be necessary prior to submitting any data.

Diagnosed with

The NHC-103 reports identify those patients who were newly diagnosed with a condition in the previous quarter. As patients are ineligible if any of these conditions are pre-existing, it is highly likely that the diagnosis in the last quarter was made as a result of the NHS Health Check.

Prescribed medication

NHC-104 reports help to identify any patient who was prescribed a statin or an antihypertensive medication during the last quarter. Again these drugs should preclude a patient from being eligible for an NHS Health Check so it would be reasonable to assume that the patient was started on the drug following the results of the NHS Health Check.

The list report NHS-110) NHS Health Check last quarter DETAILED summary provides a similar view to the data quality report but with more detail. This can be used to review the complete dataset for individual patients.

Age	Sex	BMI	GPPAQ	Alcohol screening	Cholesterol	CVD Risk	Glucose/HbA1c
Under 40 (too young)	Male	< 18.5	Active	0 - 7 (lower risk)	≤ 5.0	< 10%	< 5.5
40-44	Female	18.5 - 24.9	Moderately active	8 - 15 (increasing risk)	> 5	10 - 19%	5.5 - 6.9
45-49		25 - 29.9	Moderately inactive	16 - 19 (high risk)		20 - 29%	> 7.0
50-54		30 - 39.9	Inactive	> 20 (possible dependency)		> 30%	< 42
55-59		> 40	GPPAQ declined				42 - 47
60-64							≥ 48
65-69
70-74
Over 75 (too old)

Note: Ethnicity, smoking, and blood pressure reports return all codes recognised by QOF

Previous NHS Health Checks

1. The search version of NHS Health Check done in past 5 years counts the total number of patients who have received an NHS Health Check in the past 5 years from any provider (current surgery, previous surgery, third party), and includes patients who have left or died. 
   
2. The report version breaks down this figure by how many years ago it was done. It is possible to see if the NHS Health Checks were done at this Practice (see ODS code) or elsewhere (Organisation column is blank or states 'National').
   

Coding

These offer codes should be routinely added during the invitation process - see folder 020C NHS Health Check. 

Frequently Asked Questions

Q: There is an extra column of numbers on the reports which doesn't add up

A: If you see a blank column of numbers adjacent to your own Practice's ODS code, these have come in via GP2GP. Any data in this column should be ignored for reporting purposes.

   

Q: Why are there so many patients in the NHC-201 missing search?

A: Usually this is because a data point is missing. The search has been designed to only look at 9 core data points (Health check completed code; ethnic origin; smoking status; blood pressure; BMI; exercise grading; alcohol screening; cholesterol; QRISK).

Consider that a clinician is adding the NHS Health Check completed code when they are not actually carrying out a full health check - the report will tell you who!

Q: Will patients who had an NHS Health Check completed elsewhere be picked up?

A: Possibly. The searches have been designed to ignore cases where a patient had a health check at their previous surgery prior to re-registering (but the record came via GP2GP); this isn't fool proof so some patients may slip through. Where you have received reports of health checks being carried out elsewhere it is essential that they are coded correctly with 'NHS Health Check completed by third party'

Q: My NHC-102 search is returning 0 patients. What is going wrong?

A: Most of the codes within the core data points are standard codes which any Practice is likely to use regularly. The most likely explanations will be because an invalid Health check completed code is being used (see data quality NHC-203), or a different code is being used for the total cholesterol result.

Despite the NHS specification calling for QRISK3 - this is the only tool which can actually be calculated after March 2023 - we have kept QRISK2 as a valid code as it will support retrospective running of the searches. We recommend ensuring all clinicians use QRISK3 and compliance can be measured in data quality report NHC-205.

References

healthcheck.nhs.uk National Guidance

NHS England Enhanced Services Business Rules