Telephone outreach to increase use of NHS Health Checks among underserved communities

NHS Health Checks were introduced in 2009 to provide a health check-up for adults in England aged 40-74. They’re designed to spot early signs of stroke, kidney disease, heart disease, diabetes and dementia. They also provide people with support to help reduce their risk of developing these diseases, including help with stopping smoking, maintaining a healthy weight, being active and access to medical treatment for high-risk patients.

These diseases are more common in more deprived communities and some minority ethnic groups and this contributes to health inequalities. However, criticism of the programme includes that it attracts the ‘worried well’, and that those who could benefit most from the programme are least likely to attend an NHS Health Check.

GP practices are the main provider of NHS Health Checks, usually inviting patients by letter. In Bristol, telephone outreach has been used to encourage people in more deprived communities and minority ethnic groups to attend NHS Health Checks, with community outreach workers based in GP practices phoning patients.

Where possible, people were called by an outreach worker with a similar cultural background who spoke their language. During the call, patients were:
- invited to book an NHS Health Check
- asked lifestyle questions
- directed to healthy lifestyle services, such as support to stop smoking

Project aims
Through in-depth interviews, this study examined the views and experiences of both patients and staff of this telephone outreach approach. We wanted to find out how the intervention was delivered by the outreach workers, how the patients found it and the impact it had.

What we did
We interviewed 24 patients who were called about an NHS Health Check. We also interviewed the 10 outreach workers who made the calls and five GP practice staff who worked with them to deliver the service.

The GP practices we worked with were all in more deprived areas. English was not the first language of five of the patients interviewed, and three of these patients chose to be interviewed with an interpreter.

The patients who were called liked getting a phone invitation to an NHS Health Check. They also liked being able to book an appointment during the call. They said it made them more likely to have an NHS Health Check than if they had only been sent a letter.

Being called by someone from a similar background who spoke their language was important for some people, and it would help if matching of outreach workers to patients was improved. Most of the patients didn’t mind answering questions about their lifestyle over the telephone, and some patients said that answering these questions and being directed to healthy lifestyle services had prompted them to make lifestyle changes.

When recruiting the telephone outreach workers, Bristol City Council looked for people with:
- a range of cultural backgrounds
- good local knowledge and connections
- language skills
- experience working in supporting patients or healthy lifestyle services

All the telephone outreach workers were fluent in English, and six spoke other languages including Somali, Arabic, Urdu, Punjabi, Bengali and Hindi.

GP practice staff thought the telephone outreach workers were good at talking to the people they called, and the outreach workers described having specialist knowledge of the target communities and having a ‘bit of banter’ with patients they called to make them feel at ease. Some outreach workers found asking the lifestyle questions over the telephone difficult and time-consuming, and said that these were often repeated during the NHS Health Check appointment anyway. Some of the outreach workers were confident directing people to healthy lifestyle services, but others thought that they needed more training.

The outreach workers and GP practice staff we interviewed saw telephone outreach as a good way to engage patients in NHS Health Checks. It could also reduce the administration GP practices needed to do to invite patients to NHS Health Checks.

Some GP practice staff mentioned difficulties with fitting appointments for NHS Health Checks into their already busy schedules. Some staff weren’t clear about the aims of the telephone outreach service, meaning they might not have made full use of telephone outreach workers’ specialist skills. For example, the patient wouldn’t benefit from the outreach worker’s interpreting skills or local community knowledge if they didn’t have a similar cultural background.

For telephone outreach to reach its full potential, clear objectives for recruiting and training outreach workers are vital, along with support to set up and embed the service in GP practices.