1. Introduction London Borough of Camden Service Specification for NHS Health Checks Locally Commissioned Service 2016/17 The NHS Health Check programme aims to reduce avoidable premature mortality through early identification and management of risk factors and early detection of disease among people age 40 to 74. It is a systematic risk assessment and management programme to prevent or delay the onset of diabetes, heart and kidney disease and stroke. The NHS Health Checks programme is nationally mandated. From April 2013, Local Authorities in England became responsible for ensuring that eligible patients are offered a check every five years. In Camden, approximately 58,000 people are eligible for an NHS Health Checks; therefore 11,500 people should be offered a check every year. In 2014, Public Health England increased the uptake expectation from 50% to 66%; i.e. 66% of people who are offered an NHS Health Check will take up the offer. This equates to the delivery of 7,6 checks annually. In Camden, the majority of NHS Health Checks are delivered through General Practice. In addition, NHS Health Checks are carried out in various community settings. This is to ensure the programme is accessible to as wide a range of people as possible and help narrow health inequalities from the conditions covered by it. Results of the NHS Health Checks carried out outside general practice are sent to the relevant GP practices so that they can be entered into the patient record, and ensure patients are appropriately followed up by their GP. This Locally Commissioned Service is designed to operate in conjunction with the community-based NHS Health Checks. The Health Check Handbook for General Practice should be utilised alongside this service specification for the effective delivery of the programme. This can be downloaded here: http://gps.camdenccg.nhs.uk/service/nhs-health-checks The main differences between the 2015/16 LCS Specification and this 2016/17 version are outlined in Appendix 1.
2. Service Aims and Objectives The aims of the NHS Health Checks LCS are: To ensure practices invite 20% of their eligible patients for an NHS Health Check every year. Invitations should prioritise those patients who are at high risk of CVD (QRisk2 >20%) and those with a learning disability/ mental health diagnosis. Although one invitation plus two reminders are recommended per patient, only one invitation per patient (i.e. the invitation by letter) can be counted for payment purposes. To provide an NHS Health Check to all those who take up the offer. To enter result from NHS Health Checks carried out into the community and pharmacy into the patient record. To refer eligible and willing patients to a range of lifestyle and behaviour change services commissioned by public health and others. The specification of the LCS for NHS Health Checks covers enhanced aspects of clinical care of the patient, namely the NHS Health Check element as defined in section 5 of this service specification below. Where additional testing and follow up is required, for example when a patient is identified to be at high risk of CVD or having developed cardiovascular disease, this remains the responsibility of primary care. 3. Duration and eligibility criteria This specification will apply from April 2016. The specification wil be reviewed annually, but the contract guarantees the NHS Health Check LCS will run for at least two years from 1 st April 2015, with the option of three one year extensions.. All GP practices in Camden are encouraged to sign up to this LCS. By delivering on this LCS, practices agree to have aggregated data on numbers of patients offered a check and number of health checks offered remotely extracted by Camden CCG IT team on a quarterly basis for payment and monitoring purposes. Data will be extracted only on the Read Codes provided in Camden s NHS Health Checks template in EMIS web. Data extracted will be in aggregated and anonymous form, and will be used exclusively for payment and performance monitoring purposes. Additionally, once a year a data audit will be carried out where pseudonymised data on individual basis will be extracted for evaluation purposes. The outputs of the evaluation will 2
be shared with practices, and where requested and possible data on practice level can be provided to practices. 4. Patient Eligibility Criteria for NHS Health Check In order to be eligible for a NHS Health Check through the LCS, patients must meet all of the criteria below: Fully registered with a Camden GP. Aged 40-74 years (i.e. the NHS Health Check must be completed on or after 40 th birthday and before 75 th birthday). Not have a diagnosis or documentation of: o Coronary heart disease o Chronic kidney disease (CKD stages 3-5) o Diabetes o Previous stroke o Hypertension o Atrial Fibrillation o Transient Ischaemic Attack (TIA) o Heart Failure o Peripheral Arterial Disease o Familial Hypercholesterolemia Those currently prescribed statins should also be excluded from the programme as they are being already regularly monitored in primary care. Have NOT received an NHS Health Check in the previous 5 years. 3
5. Payment Overview Level Element Amount Payment Frequency 1 Fulfilling the Up to 370 backfill cover Annually education & for 1-2 members of staff to leadership attend the requirement launch/education event s 2 Inviting and delivering checks to target populations 1,000 per average size practice: 1/3 for inviting 20% of the eligible population; 2/3 for delivering checks to 13.2% of the eligible population (see Appendix 2 for your practice bonus). Annually Notes Practices must send at least one member of staff to attend the launch event Payment for backfill cover will be paid for up to two attendees Payment will allocated to practices based on signed attendance sheet at the NHS Health Checks event. Practices must allocate a Health Checks lead by 31st March 2016 Payment will be made after Q4 based on remote data extraction. Only the first invitation since 1 st April 2014 per patient will count towards the payment, as agreed locally. Only invitations and checks delivered in patients who are eligible for a health check will count towards the payment. The bonus parts, invitation and delivery based, are independent. Practices can achive none, one or both parts. 3 Conducting an NHS Health Check to all patients who take up the offer 35 for an NHS Health Check in eligible patients. 10 extra payment for patients with an estimated QRisk2 of 20% or greater. 5 extra payment for patients on the Mental Health or Learning Disabilities register. Quarterly Payment will only be made for checks in patients who meet the eligibility criteria in Section 6, and on completion of a full NHS Health Check, as in Section 6.2. Maximum payment will be capped based on the percentage of the practice s eligible list size per year. See Appendix 2 for details. Any additional activity delivered by practices in a given year over and above the cap will be carried over into the subsequent year. 4
6. Service Specification 6.1 Leadership and Education Requirement The practice must identify a named lead on NHS Health Checks at the practice. The practice lead does not necessarily need to be the person delivering the health checks, but a member of staff who takes responsibility for the quality and coordination of delivery of NHS Health Checks by the practice. At least one member of practice staff (GP, Practice Nurse, Healthcare Assistant or Practice Manager) must attend the Leadership and Education event. The practice must ensure all staff performing NHS Health Checks have had appropriate training. E-training was made available to all parties delivering checks in Camden and Islington by the Public Health. Process The practice must inform the Public Health Projects Manager of the allocated NHS Health Checks lead by 31 st March 2016 on kinga.kuczkowska@islington.gov.uk. The practice must register up to two staff members for the Leadership and Education event, as per instructions provided by the Public Health. The practice can request access to the e-training tool for health chcks available on Islington s e-learning portal Ollie at http://islington.learningpool.com/for their staff by contacting CIPHadmin@islington.gov.uk with the following information: Participant s full name and email address Borough Provider type (GP, pharmacy, community) Provider name Payment Practices will be remunerated with payment for complying with the Leadership and Education element of the LCS, to help cover the cost of locum cover of practice staff attending the Education event. Payment for backfill cover totalling up to 370 will be paid for up to 2 attendees at the event. The rates will be: - GP 100 per hour - Practice Manager: 35 per hour 5
- Practice Nurse: 35 per hour - Health Care Assistant: 13 per hour 6.2 Offering an NHS Health Checks to those eligible. Requirement The practice must identify and invite 20% of the practice s eligible population for a NHS Health Check during the twelve months of the LCS period. For example, if the practice s eligible population is 100, they should invite 20 patients for an NHS Health Check between 1 st of April 2016 and 30 th of March 2017. These must be new invitations, i.e. patients who have not had an invitation since 1 st April 2014, as agreed locally. The GP practice s eligible population is available in Appendix 2. Process Practices can decide how best to batch their eligible population in order to ensure that 20% are invited for an NHS Health Check over the twelve month period of the LCS. To help practices, search strategies to identify the eligible population, including those to identify priority groups, such as those with an estimated QRisk2 of >20%, and those on Mental Health and/or Learning Disability registers, searches have been provided on EMIS. If you require any help with locating this searches, please contact Camden GP IT and Systems on 0203 688 1881. Instructions on how to run the searches to identify your target population in EMIS are available in the NHS Health Checks Handbook for General Practice, available here:http://gps.camdenccg.nhs.uk/service/nhs-health-checks and on request from the amden GP IT and Systems. The following should be incorporated into the invitation process: Patients with an estimated QRisk2 >20% and those with a mental health or learning disability diagnosis should be invited first. Practices are advised to make at least three attempts to invite the patient for an NHS Health Check. However, only one invitation per patient will be counted for payment purposes. 6
The practice can decide on the most appropriate method of invitation, such as letter, text and telephone or verbal. The invitations should be coded as follows: o 9mC1 (first letter sent): o 9mC2 (second letter sent) o 9mC3 (third letter sent) o 9mC0 (telephone invitation o 9mC4 (verbal invitation) A standard NHS Health Check invitation letter produced by the Department of Health, as well as the NHS Health Check information leaflet produced by the Public Health can be used for the letter invitations. In addition to the formal invitation, practices can also offer NHS Health Checks opportunistically, i.e. during a patient consultation, especially for those patients who may be more difficult to engage with by letter or telephone.invitations should be recorded in the patient s records using the standard READ codes specified above. These have been included in the template. Payment Practices achieving a target of sending an invitation to 20% of their eligible patients during the period of the LCS (defined as first invitation after 1 st April 2014) will receive a payment after Q4. The bonus for invitations accounts for a third of a one-off payment made available to practices after the end of the LCS year of 1,000 per average eligible population size practice. The further two thirds of the bonus will be paid for delivering checks to 13.2% of the eligible population. The number of invites and checks delivered for each practice to meet this target and the remuneration each practice will receive if they meet the target is specified in Appendix 2. Payment will be made at the end of the LCS period once the total number of offers and checks delivered is known. Please note that only one invite and check per patient will be counted towards the target. Payment will be based on codes listed in this service specification. Therefore it is important practices appropriate code their activity on the template. 7
6.3 Providing an NHS Health Checks to all those who take up the offer Requirement To provide an NHS Health Check to all eligible patients who take up the offer. The NHS Health Check must be provided by an appropriately trained and qualified clinician, i.e. GP, practice nurse, or HCA. Process The NHS Health Check should be provided face to face. Full detailed information to support the delivery of an NHS Helath Check is available in the Health Check Handbook for General Practice. This can be downloaded here: http://gps.camdenccg.nhs.uk/service/nhs-health-checks and on request from the amden GP IT and Systems. A completed NHS Health Check includes the following elements: 1. Risk Assessment The following number of tests and measures to be carried out and information collected: Age Gender Smoking status Family history of CHD Ethnicity Body mass index (BMI) Cholesterol Blood Pressure Physical Activity levels (inactive, moderately inactive of active) Cardiovascular risk score (using QRisk2) Alcohol Use Disorders Identification Test (AUDIT score). Dementia component: Raising awareness of the signs and symptoms of dementia for patients aged 65-74. Pulse Check for patients age 65 74 2. Diabetes and Hypertension assessment (when indicated) Additional tests must be performed in the following circumstances: 8
Where Measurement Indicates BMI 30 (>27.5 for Black African, African Caribbean and Asian groupsethnicity) Activity Required Formal screening for diabetes mellitus (using either a fasting glucose (FPG) or an HbA1c measurement)* BP 140/90 Formal screening for diabetes mellitus (using either a fasting glucose (FPG) or an HbA1c measurement)* Screening for CKD (currently needs laboratory measurement). Ten year risk score of CVD event 20% QRisk2 Assessment for statins (see NICE guidance CG181) People at or above 20% risk without disease should be placed on a high risk register and managed accordingly through annual reviews (this will then mean they are ineligible for the Health Check programme in five years time). * Previous blood tests and other observations can be used in the Health Check providing they have been completed within the timeframes below: Non-blood results valid for up to 2 months prior to date of the NHS Health Check. Blood results valid for up to 6 months prior to the date of the NHS Health Check. Communication of Risk Everyone who has undergone an NHS Health Check should have their individual risk of developing cardiovascular disease communicated to them, including a full explanation of results, tailored to the individual needs of the patient. Management of risk factors Risk factor management and medication should be provided as appropriate. Everyone who has been diagnosed with vascular disease as a consequence of the NHS Health Check should be added to appropriate disease registers and followed up/managed as required. Payment Practices will receive a payment of 35 per NHS Health Check completed. Payment will be based on the code 8BAg code (NHS Health Check completed) being present on the patient s record. Patients will receive an extra payment of 10 per check if the patient has a QRisk2 of >20%, and an extra payment of 5 if the patient is on the Mental Health and/or Learning Disabilities register. Therefore a Health Check delivered to a patient who is on a MH/LD register and has a QRisk2 >20% would result in a payment of 50. 9
The check is not considered complete until all aspects of the check delivered, including communication or risk scores, which may, in some patients may be delayed due to additional testing for diabetes or CKD. 6.4 Entering results from community NHS Health Checks into the patient record Requirement To enter results of Health Checks completed in the community into the patient s primary care record. To ensure that patients identified in community settings with a QRisk2 of >20% are followed up and managed appropriately back in primary care. Process Practices will be sent results for their registered patients from community provider(s) via e- mail to the designated nhs.net account of the practice. Results will be sent through daily and each e-mail contains an attachment with patient information along with relevant read codes. This information should be entered into the patient record using the NHS Health Checks template and coded as a community check (EMIS CODE 38B1). In the future Public Health and the contracted community provider(s) will seek to introduce Electronic Data Transfer systems to facilitate data entry. The practices will be consulated on and informed about any changes. Follow up of patients with QRisk2 of > 20%. Results received from community health checks should be reviewed at the practice, and all patients identified as having a high risk of developing CVD (i.e. QRisk2 of >20%) should be invited back to the practice and given appropriate interventions and follow up. An average list size practice will be expected to have no more than 5 such patients. Reporting & payment The follow up of high risk patients or patients with abnormal results is considered to be part of usual clinical care and it will not be remunerated as part of this LCS. However, this work 10
will help practice achieve QOF indicators and may aid case finding for Long Term Conditions LCS. 7. Review of Service London Borough of Camden must ensure that they are compliant with any statutory duty set by the Department of Health. Camden & Islington Public Health will review the specification on an annual basis to ensure that the service is: meeting the desired objectives set out in the specification compliant with any statutory duty given by the Department of Health delivered in line with NHS Health Check Best Practice Guidance It is expected that any required changes will be made on an annual basis. However, practices will be notified if any changes are made in-year and will require immediate modification of service specification. Minor adjustments to ensure the service remains in line with PHE guidance are expected to be included without a modification of service specification. 11
Appendix 1 Summary of changes to LCS (2015/16 to 2016/17) Age eligibility: In Camden the age eligibility for the NHS Health Checks is currently extended to include those age 30 39 of South Asian background, in addition to those who are aged 40 74. This will be changed to 40-74 in the Camden GP LCS 2016/17. GP bonus payments: In Camden there is a bonus scheme for practices who invite at least 20% of their eligible population for an NHS Health Check during the duration of the LCS. This will be changed to a split target of 1/3 for inviting 20% or more of the eligible population and 2/3 for delivering NHS Health Checks to 13.2% or more of the eligible population in 2016/17. Data sharing: The data sharing agreement in the Camden GP NHS Health Checks service specification will be amended to allow remote annual extraction of pseudonymised data on individual level for evaluation purposes. Invitations: The 2015/16 GP LCS service specification states that at least two attempts should be made to invite the patient for a NHS Health Check, at least once by letter. However, one invitation per patient counts towards the 20% payment target. The requirement for a letter invitation was removed, in line with the latest evidence suggesting that this is not the most effective method of increasing uptake.
Appendix 2 Eligible population and payments, by practice, 2016/17 Pactice Code Practice Name Total eligible population for NHS Health Check Annual target for invites (20% of total eligible population) - 1/3 of bonus Annual target for NHS HCs completed (13.2% of total eligible population) - 2/3 of bonus Remuneration for invites (20% of total eligible population) - 1/3 of bonus Remuneration for HC completed (13.2% of total eligible population) - 2/3 of bonus Maximum bonus payment for invitations (20% of eligible population) and HCs completed (13.2% of eligible population) Maximum remuneration for NHS Health Checks delivered* Maximum remuneration on LCS for NHS Health Checks (based on maximum annual activity) F83658 Belsize Priory Medical Practice 1,024 205 135 207 414 621 7,168 7,789 F83023 James Wigg Group Practice 5,085 1,017 671 1,029 2,058 3,086 35,595 38,681 F83059 Brondesbury Medical Centre 3,804 761 502 770 1,539 2,309 26,628 28,937 F83019 The Abbey Medical Centre 2,451 490 324 496 992 1,488 17,157 18,645 F83017 Hampstead Group Practice 3,626 725 479 734 1,467 2,201 25,382 27,583 F83665 Swiss Cottage Surgery 2,458 492 324 497 995 1,492 17,206 18,698 F83003 The Park End Surgery 2,218 444 293 449 897 1,346 15,526 16,872 F83052 Brookfield Park Surgery 1,003 201 132 203 406 609 7,021 7,630 F83020 Adelaide Medical Centre 2,994 599 395 606 1,211 1,817 20,958 22,775 F83011 Primrose Hill Surgery 2,006 401 265 406 812 1,218 14,042 15,260 F83043 Gower Place Practice 345 69 46 70 140 209 2,415 2,624 F83623 The Keats Group Practice 3,396 679 448 687 1,374 2,061 23,772 25,833 F83055 West Hampstead Medical Centre 2,504 501 331 507 1,013 1,520 17,528 19,048 F83018 Prince Of Wales Road 1,831 366 242 370 741 1,111 12,817 13,928 F83057 Parliament Hill Surgery 1,773 355 234 359 717 1,076 12,411 13,487 F83006 Ampthill Practice 1,932 386 255 391 782 1,173 13,524 14,697 F83030 Four Trees Surgery 471 94 62 95 191 286 3,297 3,583 F83061 The Museum Practice 1,208 242 159 244 489 733 8,456 9,189 F83058 The Holborn Medical Centre 1,392 278 184 282 563 845 9,744 10,589 F83615 Cholmley Gardens Medical Centre 1,750 350 231 354 708 1,062 12,250 13,312 F83672 St Philips Medical Centre 757 151 100 153 306 459 5,299 5,758 F83635 Kings Cross Road Practice 459 92 61 93 186 279 3,213 3,492 F83025 The Regents Park Practice 1,279 256 169 259 518 776 8,953 9,729 F83005 Gower Street Practice 761 152 100 154 308 462 5,327 5,789 F83042 Grays Inn Medical Practice 892 178 118 180 361 541 6,244 6,785 F83633 Daleham Gardens Health Centre 827 165 109 167 335 502 5,789 6,291 F83677 Matthewman 473 95 62 96 191 287 3,311 3,598 F83683 Somers Town Medical Centre 645 129 85 130 261 391 4,515 4,906 F83044 The Bloomsbury Surgery 1,011 202 133 205 409 614 7,077 7,691 F83682 Rosslyn Hill Surgery 636 127 84 129 257 386 4,452 4,838 F83632 The Queens Crescent Practice 607 121 80 123 246 368 4,249 4,617 F83050 Fortune Green Practice 834 167 110 169 337 506 5,838 6,344 F83048 Brunswick Medical Centre UHPC 1,132 226 149 229 458 687 7,924 8,611 Y02674 Camden Health Improvement Practice (C 282 56 37 57 114 171 1,974 2,145 F83022 Caversham Group Practice 3,801 760 502 769 1,538 2,307 26,607 28,914 Total 57,667 11,533 7,612 11,667 23,333 35,000 403,669 438,669 *Any additional activity delivered by practices in a given year over and above the cap will be carried over into the subsequent year.