A service evaluation of the uptake and effectiveness of a digital delivery of the NHS health check service

Objectives: To compare the uptake, effectiveness and costs of a digital version of the NHS Health Check (DHC) to the standard face-to-face NHS Health Check (F2F).

Participants & setting: A random sample of 9000 of those aged 40-74 eligible for an NHS Health Check in Southwark, England between January - April 2023.

Intervention & design: The DHC was an online tool with a health assessment section, an advice and support section, and a section on how to obtain and update follow-up physical measures (blood pressure, cholesterol, glycated haemoglobin (HbA1c)). 6000 patients from GP records were randomly allocated to receive a DHC invitation and 3000 to receive a F2F invitation. Those invited to DHC were able to choose F2F if they preferred.

Outcomes: The primary outcome was uptake of any type of health check, either a completed F2F appointment or completion of the DHC health assessment section, along with demographics and data on appointments, medications and referrals within the study period. QRISK3 and QDiabetes risk scores were calculated. Management and operation costs were estimated for F2F and DHC pathways.

Results: Excluding participants due to moving away or death, DHC uptake to the health assessment section was 21% (1189/5705), with a further 3% (198/5705) choosing F2F, compared to 11% (305/2900) for F2F completion (p<0.001). DHC uptake was lower among those from Black (14%) and Mixed (13%) compared to White (29%) ethnicities (p<0.001), and there was no evidence of higher DHC uptake among groups less likely to engage in NHS Health Checks. Of those who completed the health assessment, 60% (714) completed the support section, and 7% (84) completed the provision and updating of physical measures. Appointments, medications and referrals were lower among DHC service users than F2F users (p<0.001). The estimated total management and operation costs for F2F were £154.80 per user, compared to total management and operation costs for DHC of £68.48 per user for health assessment only, £134.46 including the support section, and £1479.01 per user with completed physical measures.

Conclusions: The study suggests that a choice of Health Check pathways may potentially reduce pressures on the NHS. Cholesterol and HbA1c were not generally known and the options to obtain and update these measures require further development for the DHC to be considered a viable comparable alternative to the F2F service for estimating cardiovascular disease and diabetes risk. Strategies are still needed to reach those groups not currently engaging with NHS Health Checks.