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Decommissioning: what's the problem with health checks?

As C+D’s decommissioning and quality investigation reveals yet more concerns about pharmacy-delivered health checks, James Bloodworth asks: what is holding the sector back?

NHS health checks have been hitting the pharmacy headlines again this year, but unfortunately for all the wrong reasons.

In February, C+D Senator and managing director of health diagnostics Julie Evason warned that some trusts were dropping their health check schemes due to lack of contractor interest and cost concerns.

The topic came up again at a C+D Senate on quality in July, and this week C+D's investigation has uncovered yet more evidence of problems with the schemes, with several PCTs admitting to scrapping pharmacy health check services in the last financial year and others having concerns about them (see PCTs with health check concerns).

Scouring through the Freedom of Information Act responses received by C+D during the investigation gives a good idea of why this is happening – every PCT that cut the service mentioned poor delivery from pharmacists.

In most cases that related to activity levels, but there were also worries about competency levels and patient experience in some areas. So what exactly is so difficult for pharmacy to get right about health checks?

One of the key problems seems to have been recruiting patients, and this was down to a number of factors. Getting GPs on board was one challenge – in Dorset one pharmacist found it hard to recruit patients to the service because they had a GP surgery next door. "It's easier for them to recruit patients rather than send them to us," explains Ella Tsang of Verwood Pharmacy.

More from C+D's decommissioning investigation Decommissioning interactive PCT map

PCTs axe services amid quality concerns

Let's get real about commissionin

For others, technology was the biggest hurdle, with Durham and Cleveland LPC secretary Greg Burke telling C+D that contractors in his area had seen the IT system for their cardiovascular screening pilot "breaking down during consultations". And for some contractors the patients themselves even posed problems. "Eight out of 10 times they wouldn't turn up for the appointment," Mazhar Hussein of M Hussein Chemists in Coventry tells C+D.

Addressing these issues cannot be down to pharmacy alone. PCT promotional campaigns and support will be essential, along with appropriate pharmacy training.

As Essex LPC contractor development manager Karen Samuel-Smith puts it: "Commissioners and, to an extent, the LPC, are very good at ‘how to' training sessions, but don't do much on recruiting patients and fitting it in with other services."

But getting patients through the door is only the first step – contractors also seemed to fail on the actual delivery of the service at times.  Ms Evason told the C+D Senate that, in her experience, some pharmacies were simply not delivering health checks to the standards they had signed up to do.

Senator and LPC secretary Nick Hunter agreed, adding that "it's beyond just health checks – it's every enhanced service".

"Some pharmacies are completely unable to follow a service level agreement. With the amount of chasing up you need to do, even getting people to sign in the right place, what hope have we got?" he said.

And as Ms Samuel-Smith sums up: "Pharmacists were finding it hard to recruit patients, to fit it in with their existing business model and to delegate."

Nick Hunter

It's beyond just health checks – it's every enhanced service

It seems clear that to really move forward with health check services pharmacies are going to have to tackle these problems, as many contractors already have done successfully. Ms Evason says having a service plan in place before you take it on is essential, while others suggest involving the whole team could help.

The Senate was agreed that to do all of this pharmacy would need sufficient incentives to deliver services to the required standards.

But where that incentive is not on offer, the message was clear – if you can't deliver a service according to the agreement, don't sign up for it.


PCTs with health check concerns

Coventry The trust put its pilot healthy life check service on hold pending a wider review of the scheme across all providers. In the pharmacy pilot, concerns had been raised about the "operational costs of running the service in relation to the number of checks undertaken".

Dorset The volume of NHS health checks delivered by pharmacies had been "disappointing", according to the trust, but following changes to the eligibility criteria for the service, contractors were encouraged to continue offering them.

South West Essex Health checks were decommissioned after pharmacists delivered only 655 checks between April and December last year against a target of 4,000 annually. Of that 655, the majority were delivered by just two pharmacies. The trust also noted that the cost of checks delivered by pharmacies were "more than twice" those of checks delivered by GP surgeries.

Tees PCT cluster A pharmacy cardiovascular screening pilot was halted after a review found activity levels had remained low "leading to concerns about value for money, competency and patient experience".  

Tips for your CPD entry on delivering quality services

Reflect How well do I provide pharmacy services? Plan Identify problems with the schemes in patient recruitment or delivery. Act Work with my team to address these, providing training if needed or getting customer feedback. Evaluate Are my services now delivering better results for patients?

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