The NHS Health Check programme: a survey of programme delivery in England before and after the Covid-19 pandemic response

Introduction:
The NHS Health Check aims to identify individuals at increased risk of cardiovascular diseases (CVDs) among the adult population in England. The Health Check includes calculation of CVD risk and discussion of pharmacological and lifestyle approaches to manage risk, including referral to lifestyle support services. The programme is commissioned by Local Authorities (LAs) and is delivered by a range of different providers in different settings. There is significant variation in activity, with uptake ranging from 25% to 85% in different areas, and clear evidence of variation in implementation and delivery practice.

Methods and analysis:
We aimed to understand how the NHS Health Check programme works in different settings, for different groups, so that we could recommend improvements to maximise intended outcomes. To do so, we undertook a realist review and a survey of LA public health teams. Our review followed Pawson's five iterative stages: (1) locate existing theories, (2) search for evidence, (3) article selection, (4) extract and organise data and (5) synthesise evidence and draw conclusions. Our review included documents describing local implementation alongside published research studies. We recruited a stakeholder group (including Public Health England, commissioners and providers of Health Checks, plus members of the public and patients) to advise us throughout. Our survey was sent to all 152 LAs in England to gather detailed information on programme delivery (including COVID-19-related changes) and available referral services. This enabled us to map delivery across England and relate these data to programme outcomes.

Ethics and dissemination: For the survey, we received approval from the University of Kent Research Ethics Committee. Our findings were used to develop recommendations on tailoring, implementation and design strategies to improve delivery of the NHS Health Check in different settings, for different groups.

Prospero registration number: CRD42020163822.