NHS Health Check: national evaluation findings and implications/The authors respond to "NHS Health Check: national evaluation findings and implications"

In response to their concerns about not basing our analysis on patient attendance identified by a Read code, we have compared risk reduction in attendees identified by Read codes and nonattendees (both without a Read code or algorithm-identified attendance). The results presented in Table 1 suggest a smaller impact of the NHS Health Check when attendance is defined using Read codes. This finding implies that using the algorithm did not result in underestimation of program impacts. However, we agree that looking at longer-term impacts of the program are important, including an examination of the impacts of brief lifestyle advice. The success of universal cardiovascular disease risk assessment programs is dependent on high uptake and delivery of effective interventions. Although the performance of the NHS Health Check has improved, current uptake of 49% seven years after the program started requires attention.4 This is especially so, given the program has benefited from substantial investment and is being delivered in a system with universal health coverage, well-developed primary care, and very high electronic medical records use. On a more positive note, the program appears equitable with similar attendance among patients living in wealthier and poorer areas, although our previous findings of significantly lower participation among Black and Chinese communities is concerning.2 Our findings also suggest that the NHS Health Check may have improved detection of hypertension, type 2 diabetes mellitus and chronic kidney disease.3 A recent microsimulation study performed by Kypridemos and colleagues5 has estimated the impact of NHS Health Check on morbidity and mortality from cardiovascular disease, and compared that with other public health strategies. The authors found that universal screening was the least effective strategy in reducing health inequalities, whereas a combination of population-wide intervention and targeted screening (for the most deprived areas) was the most effective. These findings highlight the ongoing need to invest in whole population interventions alongside programs that target high-risk individuals, such as the NHS Health Check.