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Community Pharmacy NHS Health
Checks
2010/11
2011/12
Service Specification
March 2010
Version control
Version
number
V1
Date
Author/Editor
Changes/comments
30/9/09
Neemisha Tailor
V2
V3
8/10/09
16/11/09
Julie Billett
Ian Sandford
V4
26/11/09
Ian Sandford
V5
8/3/10
Ian Sandford
Revised following interval project
group meeting and feedback from J
Billett.
Further revisions/edits.
Revision of thresholds etc,
references added.
Clarification of payment
mechanisms/dates (section 13)
Final review
Community Pharmacy NHS Health Checks
Service Specification 2010/11
Contents
1.
Purpose
2
2.
Description of the Health Check service in community pharmacy
3
3.
Scope
10
4.
Patient pathways
12
5.
Service Delivery
16
6.
Referral, Access and Acceptance Criteria
17
7.
Equipment
18
8.
Patient and Carer Information
19
9.
Quality Assurance
19
10. Marketing and Publicity
20
11. Activity
20
12. Payments to pharmacies
20
13. Information Governance
21
14. Monitoring, Evaluation and Service Improvement
22
15. Duration and Annual review
22
1
1. Purpose
1.1
Aims
The NHS Health Check programme is a national programme, launched in 2008, which aims to assess and
manage individuals’ cardiovascular risk. In doing so, it intends to prevent the development of cardiovascular
disease, including coronary heart disease, diabetes and chronic kidney disease, and reduce the incidence of
heart attacks and stroke.
As part of its local delivery of the NHS Health Checks programme, NHS Islington will commission is
commissioning NHS Health Checks in community pharmacies. These opportunistic community pharmacy
Health Checks will support the early identification of cardiovascular risk factors in 35 to 74 year olds across
the most deprived wards in Islington. Up to ten community pharmacies will be commissioned to provide a
cardiovascular risk assessment (Health Check) enhanced service. In addition to identifying and assessing
cardiovascular risk factors, the programme seeks to support people to manage their risk through lifestyle
advice, onward signposting and referral for additional support and pharmacological interventions where
indicated.
1.2
Context and Evidence Base
Cardiovascular disease (CVD) is the biggest killer in London and the largest cause of health inequalities.
Cardiovascular disease differentially affects black and minority ethnic groups and socially disadvantaged
populations.
Islington is an area of multiple deprivation, ranked the eighth most deprived borough in England, and fourth
in London. Deaths from CVD are the single largest contributor to the inequalities gap in life expectancy
between Islington and England. The life expectancy for men and women in Islington (2005 - 2007) is 75.1
and 80.8 years respectively. This is significantly lower than that for men and women in England (77.7 and
81.8 years respectively).1
Rates of CVD mortality are higher in Islington than the average for England and Wales (E&W). Directly
standardised mortality rates from all causes of cardiovascular disease in Islington are 240 per 100,000
compared with 193 per 100,000 population for England and Wales. Premature mortality rates for individuals
below 75 years in Islington are also significantly higher than for England and Wales (120 per 100,000
compared to 79 per 100,000 population). (All data are for the 3 year period 2005-2007).2
Vascular disease also causes significant morbidity and poor quality of life for individuals who are affected by
it.
The Department of Health has predicted that full implementation of the NHS Health Check programme
nationally will prevent at least 9,500 heart attacks and strokes a year (2,000 of which would be fatal), and
prevent 4000 people from developing diabetes each year.3
1.3
Overview of NHS Health Checks in Community Pharmacy
Ten community pharmacies that meet the eligibility criteria (refer to section 3.1) will be commissioned to
opportunistically identify patients aged 35 to 74 years, who are registered with an Islington GP (or who are
resident in Islington and not registered with any GP) and are not currently being treated for CVD, diabetes,
atrial fibrillation or peripheral artery disease. They will opportunistically assess individuals in order to
establish their risk of developing cardiovascular disease over the next 10 years, through completion of a
questionnaire, simple measurements and finger-prick blood testing. Following the cardiovascular risk
assessment, pharmacists will offer individuals a tailored package of advice, support and signposting to
enable them to manage and reduce their risk. Please note that the term NHS Health Check was previously
known as the Vascular Risk Assessment or Vascular check, and these terms are often used
interchangeably.
National Centre for Health Outcomes Development http://www.nchod.nhs.uk/
National Centre for Health Outcomes Development http://www.nchod.nhs.uk/
3 Department of Health (2008) Putting prevention first Vascular Checks: risk assessment and management.
1
2
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digi
talasset/dh_083823.pdf
2
1.4
Objectives
To conduct 2000 NHS Health Checks per annum in a community pharmacy setting on eligible individuals
aged 35 to 74 year olds across Islington.
Each commissioned community pharmacy will be expected to meet an indicative quarterly target of 50
Health Checks.
2. Description of the Health Check service in community pharmacy
Figures 1 and 2 (pages 14 and 15) provide a diagrammatic overview of the Health Check programme.
The NHS Health Check will take place in a private consultation room and will be conducted as a face-to-face
check between the pharmacist and the individual. Delivery of an NHS Health Check in a community
pharmacy setting comprises the following three main components:


The initial assessment process
Recall and Referral
Life style advice, support and signposting
Each of these components is described in more detail below.
2.1
Phase I: The initial screening process
All individuals participating in the NHS Health Check will be required to sign a consent form. Pharmacists will
print out this consent form using the dedicated software package in order for this to be signed and a copy
retained by the pharmacist. Individuals will not receive an assessment without signing the consent form.
The initial screening session and NHS Health Check will be facilitated by a dedicated software package
(Cardiopod) and will include an assessment of lifestyle habits and a range of health measurements and
tests. These standard questions and assessments are described below.
Standard questions:
 Age (calculated from date of birth and recorded in years)
 Gender (recorded as male or female)
 Ethnicity (self assigned from a pre-defined list)
 Patient’s address and postcode
 Registered GP (state postcode/location/name of GP practice- selected from a drop down list)
 Smoking status (recorded as smoker or non-smoker)
 Alcohol consumption based on the AUDIT-C Screening Tool
 Physical activity based on GPPAQ
 Consumption of fruit and vegetables
 Family history (any history of coronary heart disease, in a first degree relative under the age of 60
years. First degree relative means biological mother, father, brother or sister)
 Known pre-existing cardiovascular disease, diabetes, atrial fibrillation or peripheral artery disease
 Current prescriptions specifically for the treatment of cardiovascular disease (includes aspirin,
beta blockers, calcium channel blockers, ACE inhibitors, A2 receptor blockers, alpha blockers,
diuretics, and other medications used to treat CVD).
Measurements:
 Height (recorded in cm) and Weight (recorded in kg) for calculating Body Mass Index (BMI)
 Blood pressure measurements (recorded in mmHg)
Simple blood test: (Finger-prick test):
 Total cholesterol (TC) and HDL cholesterol (non-fasting) (for all individuals receiving an NHS
Health Check).
 Fasting blood glucose (for selected patients who meet the specified criteria - refer to section
2.2.3)
2.1.1 CVD risk score and risk communication
Using the standard information obtained from the patient, the dedicated Health Check software package will
then generate a CVD risk score for the individual. The risk score uses the QRISK2 risk engine. The QRISK2
engine, validated for use in the UK, gives a risk score which takes into account factors such as ethnicity,
3
family history, and deprivation status. For these reasons, QRISK2 is the preferred risk engine for use in
Islington. 4
All individuals accessing the service should receive a full explanation of their results and be provided with a
printed copy of them, along with relevant information on health lifestyles and provided documentation by the
accredited pharmacist.
Depending upon the results of their Health Check, individuals will be offered a range of appropriate advice
and support (see sections 2.2 and 2.3 below). This will include:
2.2

Lifestyle advice:
o Smoking cessation advice for smokers, and referral to in-pharmacy or other local
smoking cessation services for ongoing support and encouragement to quit
o Dietary advice, healthy eating and ways to increase fruit and vegetable consumption
o Advice on sensible alcohol consumption
o Advice on keeping active and getting involved in regular exercise. Individuals will be
referred to the Exercise on Referral (EoR) scheme, where they meet the criteria for
inclusion (see section 2.3.5 for EoR criteria)
o Referral to a health trainer, where the individual meets the eligibility criteria for the health
trainer programme.

Recall back to the community pharmacy for a fasting blood glucose and repeat BP measurement
for eligible patients (see paragraphs 2.2.2 to 2.2.4).

Referral to their GP for further assessment. In this service level agreement “GP” means “General
Practitioner” or “Practice Nurse”, depending on their individual circumstances and their registered
practice’s policies.
Phase II: Recall and Referral
2.2.1 Individuals requiring direct referral to their GP (HIGH RISK)
The high risk group includes all individuals with a 10-year CVD risk score ≥20%. In addition, individuals
with a 10-year CVD risk score <20% but who are found to have any one of the additional risk factors
described below will also be included in the ‘high risk’ group. These individuals will require direct referral to
their GP for further assessment, review of their risk factors and pharmacological interventions where
indicated. The pharmacist conducting the assessment should offer a full explanation of the individual’s CVD
risk and the reason for referral, and provide lifestyle advice on managing CVD risk.
The following individuals require direct referral to their GP or practice nurse, based on the results of the
initial screen (Phase I of the NHS Health Check):

Individuals with a 10-year CVD risk score (QRisk2) ≥ 20 % should be asked to see their GP
within 4 weeks

Individuals with a Blood Pressure ≥ 160/100mmHg, or with an isolated systolic or diastolic BP
reading ≥ 160 or ≥ 100mmHg respectively, irrespective of their 10-year CVD risk score.5

Individuals with a random cholesterol reading ≥ 7.5 mmol/L, irrespective of their 10-year
CVD risk score. (Where the initial cholesterol reading is ≥ 7.5 mmol/L, the test should be
repeated by the accredited pharmacist to ensure that the elevated level is not a false reading.
Referral is indicated if the repeat cholesterol value is ≥ 7.5mmol/L).6
4
Julia Hippisley-Cox, J. et al. Predicting cardiovascular risk in England and Wales: prospective derivation
and validation of QRISK2. BMJ 2008;336:1475-82
5 Williams.B. et al Guidelines for management of hypertension: report of the fourth working party of the
British Hypertension Society, 2004—BHS IV. Journal of Human Hypertension (2004) 18, 139–185. Evidence
for NICE CG34 (2006) Management of hypertension in adults in primary care.
6 The total cholesterol threshold for this service is set at 0.5mmol/l below that in NICE guidance to take
account of the use of point of care testing. NICE CG71 (2008). Identification and management of familial
hypercholesterolaemia.
4
2.2.2 Individuals requiring recall to the community pharmacy
Individuals who have a calculated 10-year CVD risk score less than 20% may or may not require recall to the
community pharmacy for further tests. The presence or absence of risk factors, as described below, will
govern whether an individual requires further assessment. In order to identify whether recall to the pharmacy
is required, the diabetes and hypertension filters should be applied. These are described in detail in 2.2.3
and 2.2.4 but are summarised briefly below. Where recall is indicated, individuals should be asked to return
to the community pharmacy after 48 hours. This allows patients to prepare for a fasting blood test, which
requires that the patient does not eat or drink anything other than plain water for at least 8 hours before the
test.
The following individuals should be recalled to the community pharmacy for further assessment, based on
the results of their initial screen (Phase I of the Health Check):

Individuals with a 10-year CVD risk score (QRisk2) less than 20% AND a blood pressure reading
≥ 140/90mmHg but <160/100 mmHg, OR with an isolated systolic BP reading ≥ 140 but < 160
mmHg or an isolated diastolic BP reading ≥ 90mmHg but < 100mmHg.
AND / OR

Individuals with a 10-year CVD risk score (QRisk2) less than 20% AND a BMI ≥ 30, or ≥ 27.5 if
Indian, Pakistani, Bangladeshi, South Asian, other Asian or Chinese ethnic origin.
Individuals who are recalled to the community pharmacy after 48 hours will be offered a repeat blood
pressure measurement and a fasting blood glucose (FBG) using finger-prick testing. This is discussed further
in the subsections below headed Diabetes filter (2.2.3) and Hypertension and Chronic Kidney Disease filter
(2.2.4).
2.2.3
Diabetes Filter (please also refer to the patient pathway for diabetes and hypertension, Figure 2,
grey shaded area, page 13)
The purpose of the diabetes filter is to identify those individuals who are deemed to be at high risk of
developing diabetes, based on the presence of risk factors; and to facilitate GP referrals for further
assessment where indicated. Risk factors associated with an increased risk of developing diabetes include:


High blood pressure (BP)
High body mass index (BMI)
Individuals, who have a BP reading of  140/90mmHg but <160/100mmHg, OR an isolated systolic BP
reading of  140mmHg but <160mmHg or an isolated diastolic BP reading  90mmHg but <100mmHg
respectively, will be invited back to the pharmacy for a fasting blood glucose using finger-prick testing, plus a
repeat BP measurement (see hypertension filter, section 2.2.4 below). They will be asked to return to the
pharmacy after 48 hours for these tests.
Individuals with a BMI  30 (or  27.5 if Indian, Pakistani, Bangladeshi, south Asian, other Asian or Chinese
ethnic origin) will also be invited back to the pharmacy for a fasting blood glucose test, using finger-prick
testing and a repeat BP measurement. They will be asked to return to the pharmacy after 48 hours for these
tests.
Individuals will need to return for the second assessment 48 hours after the initial assessment, in view of the
fact that they are required to have a fasting blood test on the recall visit.
Individuals will be given clear verbal and written instructions by the pharmacist, NOT to eat anything, and not
to drink anything (except plain water) for 8 to 14 hours (usually overnight) prior to the blood test. 7 Individuals
need to have a clear understanding about what a fasting blood test entails, and must be advised that failure
to comply with the instructions given will distort the results of the blood test, and may lead to unnecessary
GP referrals and subsequent investigations.
Diabetes UK. http://www.diabetes.org.uk/Get_involved/Raising-awareness/Silent-Assassincampaign/What-happens-when-you-are-tested-for-diabetes/
7
5
Individuals who are found to have a FBG level > 3.0 mmol/L but < 5.6 mmol/L do not need a referral to their
GP and should be given appropriate lifestyle advice. (See section 2.2.7)
Individuals who are found to have a FBG level ≥ 5.6 mmol/L but ≤11.0 mmol/L will be referred to their GP
for further assessment and diagnostic tests to exclude or confirm the presence of Impaired Fasting Glucose
(IFG), Impaired Glucose Tolerance (IGT) or Diabetes Mellitus (DM).8 Patients should be advised to see their
GP within 2 weeks. Pharmacists should be aware that failure to adequately cleanse the finger from which
blood is drawn may lead to an artificially high glucose reading.
Where individuals are found to have a FBG level ≥ 11.1 mmol/L, the pharmacist should repeat the blood test
ensuring that the patient’s and pharmacist’s hands are clean and dry, as failure to adequately cleanse the
finger from which blood is drawn may lead to an artificially high glucose reading. Where a reading of ≥11.1
mmol/l is confirmed by a second blood test, the patient should be advised to see their GP within 48 hours.
Where the patient complains of feeling unwell, the pharmacist should contact the patient’s GP for further
advice. Where the patient is not registered the pharmacist should contact the nearest GP for advice.8
Where the FBG level is ≤3.0mmol/L,9 the pharmacist should carry out the internal quality control procedure
(IQC) on the point of care analyser, as a low glucose reading in an otherwise apparently well individual
would be unusual. If the results of IQC are normal, re-test the patient’s blood ensuring that the correct
quantity of blood is drawn and correctly inserted into the analyser. If on the second test the FBG level
remains ≤3.0mmol/l, the pharmacist should contact the patient’s GP for further advice. Where the patient is
not registered with a GP, the pharmacists should call the nearest GP for advice. The patient may be given a
sugary drink or biscuit if (s)he is feeling unwell.
Pharmacists should be aware that there will be a cohort of individuals who do not meet the criteria for the
diabetes filter, but who will still be at significant risk of developing diabetes mellitus. These individuals
include:





Individuals with a first degree relative with diabetes.
Individuals with end-organ damage known to be associated with diabetes, for example
retinopathy, kidney disease, neuropathy.
Women who have had previous gestational diabetes.
Individuals with existing medical conditions known to be associated with diabetes, for example,
polycystic ovarian syndrome, severe mental health disorders.
Individuals currently taking medications known to increase the risk of developing diabetes, for
example, oral corticosteroids.
Pharmacists should consider the situation of each individual, and offer fasting blood glucose testing where
they regard this as being appropriate.
2.2.4
Hypertension and Chronic Kidney Disease Filter (CKD) Filter (please also refer to the patient
pathway for hypertension and CKD, Figure 4, p17)
High blood pressure is a known risk factor for developing CVD. The purpose of the hypertension and CKD
filter is to identify those individuals who may already have established hypertension, and refer them to their
GP for further assessment. This further assessment in general practice may include a venous blood test to
detect the presence of early CKD changes (serum creatinine and eGFR).
Individuals, who have an initial BP reading of  180/110mmHg, OR an isolated systolic or diastolic
readings of  180mmHg and  110mmHg respectively, should be referred directly to their GP for a
hypertension assessment. Patients should be advised to request to see the GP within 48 hours. Such
individuals will need GP-led assessments and are more likely to require pharmacological interventions to
manage their blood pressure.
Individuals, who have an initial BP reading of  160/100mmHg, OR an isolated systolic or diastolic
readings of  160mmHg and  100mmHg respectively, should be referred directly to their GP or Practice
8
Royal Pharmaceutical Society of Great Britain / Diabetes UK (2004) UK Practice Guidance on the Care of
People with Diabetes. London: Royal Pharmaceutical Society of Great Britain
9 Patient UK. Emergency Management of Hypoglycaemia.
http://www.patient.co.uk/doctor/Emergency-Management-of-Hypoglycaemia.htm
6
Nurse for a hypertension assessment. Patients should be advised to see their GP/Practice Nurse within two
weeks.
Individuals, who have a BP reading of  140/90mmHg but <160/100mmHg, OR an isolated systolic BP
reading of  140mmHg but <160mmHg or an isolated diastolic BP reading  90mmHg but <100mmHg
respectively, will be invited back to the community pharmacy for further assessment after 48 hours.
Further assessment at recall will include a repeat BP, and a fasting blood glucose test using finger-prick
testing. (see Section 2.2.3 above) Individuals will be given clear verbal and written instructions by the
pharmacist, NOT to eat anything, and not to drink anything (except plain water) for 8 – 14 hours (usually
overnight) prior to the blood test.7 Individuals need to have a clear understanding about what a fasting blood
test entails, and must be advised that failure to comply with the instructions given will distort the results of the
blood test, and lead to unnecessary GP referrals and subsequent investigations
If on repeat measurement, an individual continues to have raised blood pressure (≥ 140/90mmHg, OR with
an isolated systolic or diastolic BP reading ≥ 140 or ≥ 90mmHg respectively), they should be referred to their
GP or practice nurse for a full hypertension assessment in 4 to 12 weeks (see section 2.2.5 below).
If on repeat measurement, an individuals BP is lower than 140/90 mmHg, appropriate lifestyle advice and
signposting should be offered in order to reduce their CVD risk.
2.2.5
Individuals with very high or very low blood pressure readings
HIGH blood pressure:
It is important to recognise and respond appropriately where individuals are found to have very high blood
pressure readings, where:




Systolic and or diastolic BP  180mmHg or  110mmHg respectively10 (with symptoms) or
≥200/110mmHg without symptoms requires referral to the GP with the patient advised to see
the GP within 48 hours
BP  160/100mmHg, or systolic or diastolic BP is  160mmHg and 100mmHg but less than
180/110mmHg requires referral to the GP with patient advised to see the GP/Practice nurse
within 2 weeks.11
BP ≥ 140/90mmHg or systolic or diastolic BP is  140mmHg and 90mmHg requires recall to
the pharmacy after 48 hours for a repeat blood test (see section 2.2.4 above). 12 Where BP
remains ≥140/90 but ≤160/100, the patient should be offered lifestyle advice and advised to
see their GP in 4 to 12 weeks.13
Common symptoms include: visual disturbances, paralysis or parasthaesia, sudden severe
headache, blackouts, seizures and other alarming symptoms.
Where the patient meets the criteria above, the pharmacist should call the patient’s GP for further advice.
Where the patient is not registered with a GP, the pharmacist should call the nearest GP for advice.
LOW blood pressure:
Individuals with very low BP readings should be assessed according to whether or not they are experiencing
symptoms related to hypotension (low BP). Hypotension usually occurs where the blood pressure is
<90/60mmHg. On its own, low blood pressure does not always cause symptoms. If the patient has low blood
pressure, and does not have any symptoms, the patient does not require treatment.14 The value at which
individuals become symptomatic varies widely, so individuals found to have a BP <90/60mmHg MUST
therefore be asked about the presence of symptoms:
10
NICE CG34: Management of hypertension in adults in primary care.
NICE Guidance (CG34) recommends that GPs consider drug therapy for patients with persistent
BP≥160/100
12 Mild high blood pressure with no other increased risk e.g. high cholesterol) can usually be managed
without medication. http://www.patient.co.uk/health/High-Blood-Pressure-A-Summary.htm
13 NICE Guidance (CG34 ) recommends that blood pressure measurements should be taken at monthly
intervals to identify hypertension.
14 NHS Clinical Summaries.
11
http://www.cks.nhs.uk/patient_information_leaflet/Blood_pressure_low
7

Cardinal symptoms of hypotension include light-headedness, dizziness, fainting and
collapse. Other symptoms include chest pain and unresponsiveness.

Hypotension can be life-threatening. Shock occurs when the blood pressure is persistently
low; the flow of blood is too low to adequately deliver oxygen and other nutrients to vital
organs, such as the heart, kidneys, lungs, liver and brain. This can rapidly lead to organ
failure and even death.

Asymptomatic hypotension in healthy individuals does not require treatment.

Individuals who are found to be hypotensive with any of the symptoms described above
(light-headedness, dizziness, fainting), but are still responsive should be positioned to lie on
their back with legs lifted, e.g. on a chair. This will increase venous return (blood flow) to the
critical organs (heart, lungs, brain). At the same time, the pharmacist should arrange for the
individual to be taken to their local A&E department via ambulance, for further assessment.

Unresponsive patients, or those with severe symptoms associated with hypotension, should
be sent to the local A&E department, via ambulance for further assessment.
2.2.6 Raised cholesterol with no other risk factors
All individuals accessing the service will receive a random cholesterol check using finger-prick testing, which
will measure total and HDL cholesterol levels.
Where the total cholesterol level is found to be raised, the decision about whether an individual needs to be
referred to their GP for further assessment and commencement of lipid lowering therapy depends on that
individual’s 10-year CVD risk. According to NICE guidelines, lipid lowering therapy is recommended as part
of the management strategy for the primary prevention of CVD in individuals who have ≥ 20% 10-year risk of
developing CVD. All patients with a CVD risk score ≥ 20% should be referred to their GP.
Where the total cholesterol value is ≥ 7.5 mmol/L, or <3.0mmol/L on initial testing, the test should be
repeated to ensure that the value is a true reading.
Individuals found to have a raised total cholesterol level ≥ 7.5 mmol/L, irrespective of their overall CVD
risk, should also be referred to their GP within 2 weeks for further investigations to rule out secondary
causes of hypercholesterolaemia and disorders of lipid metabolism.15 Individuals with a raised total
cholesterol of 6.5mmol/l to 7.4mmol/l should be advised to see their GP or practice nurse within 4 weeks.
Individuals should be given a full explanation as to why they are being referred for investigations in such
cases.
Individuals with a total cholesterol level > 5.0 mmol/L but < 6.5 mmol/L, with NO other key risk factors for
CVD (i.e. high CVD risk score, raised BP and or BMI ) should be offered intensive lifestyle advice about what
they can do to reduce their cholesterol level without the need for pharmacological intervention.
2.2.7
Phase III: Lifestyle Advice, Support and Signposting (please also refer to patient pathway for
lifestyle advice and signposting, Figure 5, p18)
On completion of a NHS Health Check, all individuals, irrespective of their overall CVD risk score or risk
factors, should be offered lifestyle advice on managing their cardiovascular risk. Advice should be tailored to
each individual’s needs, and the presence or absence of potential cardiovascular risk factors. Lifestyle
advice is discussed in more detail below.
2.3
Smoking cessation:



15
Individuals who smoke or who use other forms of tobacco should be offered a discussion with an
on-site Level 2 smoking advisor.
Referral to smoking cessation services for ongoing support and help with stopping smoking
should also be encouraged.
Printed information on smoking cessation should be given to all current smokers.
NICE CG71 (2008). Identification and management of familial hypercholesterolaemia
8
2.3.1
Sedentary lifestyle:




2.3.2
Overweight and Obesity (BMI >25):



2.3.3




Individuals should be offered advice on the importance of making simple dietary changes in
order to lower their cholesterol levels without the need for commencing lipid lowering treatment.
Lifestyle advice should focus on an explanation of what cholesterol is, and that reducing
cholesterol levels can lower one’s risk of developing CVD.
Specific dietary advice is discussed in detail in section 2.3.4 below.
Patients with a total cholesterol reading of 6.5 to 7.4mmol/l should be referred to their GP or
practice nurse within 4 weeks in addition to lifestyle advice
Patients with a total cholesterol reading of 7.5mmol/l and above should be referred to their GP or
practice nurse within 2 weeks in addition to lifestyle advice.
Healthy eating and dietary advice:









2.3.5
Individuals should be offered general advice on eating healthily (see below).
Individuals should be informed about the aim of the Exercise on Referral (EoR) programme, as a
means of facilitating and offering ongoing support with weight loss. Referrals to the EoR scheme
should be made where individuals are motivated to participate in the scheme, where they meet
the inclusion criteria and where they have consented for a referral to be made.
Criteria for inclusion in the EoR scheme:
 Overweight/Obese (BMI >25)
 Cardiovascular disease
 Diabetes (type I or II)
 Depression (mild/moderate)
 Chronic respiratory disease
 Musculoskeletal disorders/injuries (must be referred to physiotherapist first)
High cholesterol (>5.0mmol/l):

2.3.4
Pharmacists should offer advice regarding the health benefits of keeping active.
Individuals should be encouraged to participate in 30 minutes of moderate physical activity, on
most days of the week.
Explaining to individuals that ‘moderate physical activity’ means any form of exercise that gets
you warm, mildly out of breath, and mildy sweaty, e.g. brisk walking, jogging, cycling, swimming.
Information on how individuals can increase their physical activity.
Pharmacists should reinforce the importance of eating healthily in order to reduce weight and
cholesterol levels, and give the following dietary advice.
At least 5 portions of fruit and vegetables daily (includes fresh, frozen, canned and dried).
The bulk of most meals should be starch based foods, e.g. cereals, wholegrain breads, potatoes,
rice, pasta.
Reducing intake of fatty foods, e.g. fatty meats, cheese, butter, full-fat milk, cream and fried food;
and substituting these products with low fat options, and using mono- or poly-unsaturated oil.
Include 2-3 portions of fish per week, at least one of which being ‘oily’ fish, e.g. herring,
mackerel, sardine, kippers, salmon, fresh tuna
Reducing salt to no more than 6 grams daily
Individuals who eat meat should choose lean meat or poultry (chicken)
Using sunflower, olive or rapeseed oil for frying
Reducing alcohol intake to no more than three to four units (men) or two to three units (women)
daily, with at least two or three alcohol-free days each week.
Health Trainers


Health Trainers have been trained to support people in the local community to make lifestyle
changes that can help them improve their health, such as taking up regular exercise, eating a
healthier diet, giving up smoking or drinking less alcohol
Providing six one-to-one sessions, a Health Trainer will work with you to develop a Personal
Health Plan which identifies the areas in your lifestyle that you want to improve and the actions
9

2.3.6
you can take to achieve your goals. Health Trainers focus on four main areas: healthy eating
physical activity, smoking and alcohol
Provide patients with Health Trainer’s leaflet.
Individuals who are resident in Islington, but unregistered with a GP

Unregistered individuals should be offered clear advice on how they can register with a GP. The
advice should include:




Names and locations of local GP practices
Contact numbers for Islington PCT
Details of the relevant information that may be required in order to register with a GP
Verbal and written information should be provided
3. Scope
3.1 Eligibility Criteria for Pharmacists & Pharmacies
The Health Check service can only be provided by pharmacists / pharmacies that meet the following
eligibility criteria:3.1.1 Community pharmacies are ideally suited to provide this service, particularly as pharmacies are
often open at weekends and have extended weekday opening hours beyond 5pm. For provision of this
service, pharmacies must be open 6 days per week and on weekdays beyond 5.00pm, unless otherwise
agreed with NHS Islington.
3.1.2
There must be at least one pharmacist accredited to undertake health checks present at all times
when the pharmacy is open. This will require two pharmacists from each participating pharmacy to be
accredited for providing NHS Health Checks.
3.1.3 All pharmacists involved in the delivery of the community pharmacy Health Check service must have
an appropriate level of competency to undertake these services.
3.1.4 Pharmacists will be required to attend a 1½ day training programme in Health Checks in community
pharmacy prior to service provision, and will also be expected to attend yearly training updates. These
training programmes will be provided by Islington PCT and will be reimbursed
3.1.5 Training will include use of the Telehealth CardioPod system and use of Point of Care Testing
equipment, in addition to other aspects of the health check. Competency in the use of the POCT and other
equipment used in the NHS Health Check will be assessed, and a certificate of completion of training will be
issued. Pharmacists will only receive access to the CardioPod system once they have attended training and
registered for a username and password.
3.1.6 Pharmacists are should have passed the Centre for Pharmacy Postgraduate training (CPPE)
Vascular Risk Focal Point training (or other equivalent) which supports this service.
3.1.7 Pharmacists will be expected to complete level II vulnerable adult safeguarding training when such
training is introduced in Islington.
3.1.8 All participating community pharmacies must have a suitable private consultation room on-site,
where they can discuss issues relating to the Health Check with individuals in private. A suitable private
consultation room is defined as a separate room within the premises with a closed door, where
conversations between the pharmacist and client cannot be heard by those outside the room. The room
must comply with the usual health and safety and infection control requirements, with appropriate patient
access to hand washing facilities.
3.1.9 All community pharmacies must offer smoking cessation services through an on-site trained Level 2
advisor and are expected to offer smoking cessation advice with appropriate referral to patients identified as
smokers during the health check.
3.1.10 Community pharmacists must develop and maintain systems for effective communication with local
GPs.
10
3.1.11 Pharmacists and any other staff involved in delivery of the Health Check programme must hold a
valid Criminal Records Bureau (CRB) check certificate, which is updated every 3 years.
3.1.12 The community pharmacy must have access to the following:
 Internet access and access to nhs.net email
 N3 broadband connection
 Telephone and Fax machine
3.1.13 There are several criteria relating to blood tests that must be met:





Pharmacists must demonstrate competency in taking blood tests using the finger-prick method.
Pharmacists and other staff involved in taking blood samples, or handling blood products will be
vaccinated against Hepatitis B infection, and shown to have made a serological response to the
vaccine. This service will be provided by the occupational health department that is responsible
for the pharmacist.
Pharmacies involved in blood testing will have hand-washing facilities and suitable work
surfaces.
An infection control policy covering the infection control process, including hand hygiene,
standard precautions, sharps safety, clinical waste and cleaning and disinfection of equipment
must be in place.
Pharmacists involved in blood testing will attend an Infection Control training session as part of
the 1½ days training (see section 3.1.6) and be able to demonstrate good clinical practice with
regard to the infection control process, including hand hygiene, standard precautions, sharps
safety, clinical waste and cleaning and disinfection of equipment, and have access to and
knowledge of using blood spillage kits.
3.2
Health Check Inclusion Criteria
The NHS Health Check will be provided to individuals who fulfil the following criteria:

Age 35 – 74 years inclusive.

No known pre-existing CVD (Coronary heart disease, stroke, transient ischaemic attack (TIA)) or
chronic kidney disease, diabetes, hypertension or raised cholesterol.

Islington resident (whether or not they are registered with an Islington GP).

Non-Islington residents who are registered with an Islington GP.

Individuals should not have received an NHS Health Check within the previous 2 years, in any
setting.

Individuals who are not resident in Islington and not registered with an Islington GP will not be
eligible for a Health Check under the Islington community pharmacy Health Check service.
Pharmacists are able to offer such individuals a Health Check at their own discretion, but should
be aware that they will not be paid for this check by Islington PCT and any consumable costs will
be recovered by the PCT from the pharmacy. This may not be provided as a private service paid
for by the patient.
3.3
Interdependencies
This enhanced service for Health Checks in community pharmacy is part of the overall programme of NHS
Health Checks that is being developed and rolled out in Islington. Currently, general practitioners are also
offering NHS Health Checks to selected patients, under the Local incentive Scheme 2009/10 (CVD and
Obesity). Patients at high risk (≥20% CVD risk) are the primary focus of this programme in general practice
in 2009/10).
It is generally acknowledged that smoking is the single most preventable cause of death and disability in the
UK. Cardiovascular disease is the second most common cause of death from smoking in the UK.
Pharmacists providing health checks are expected to offer smoking cessation advice and services in line
with their Smoking Cessation enhanced service to all patients who are identified as smokers as part of the
health check process.
11
4. Patient pathways
Figure 1: Delivering a Vascular Risk Assessment
and Management Programme
(NHS Health Checks)
Figure 1 provides a diagrammatic overview of the cardiovascular risk assessment and management process. It should be
noted that whilst the national programme targets all individuals aged 40-74 years, a lower threshold of 35 years is being
used in Islington, to reflect the higher risk in areas of deprivation and ethnic diversity.
Population: 35 – 74 year olds (inclusive) without established
cardiovascular disease or diabetes
Within General Practice
Systematic/Pro-active
Outside General Practice
Community Pharmacyopportunistic
Coronary Heart Disease, Stroke, Hypertension, Diabetes and CKD Risk Assessment
Standard Questions
Measurements
Blood Tests
Risk Management
Spectrum
Source: Putting Prevention First
LOW risk
MODERATE risk
HIGH risk
Disease
Identified
Advice
Advice and
Assistance
Advice and
Intervention
Existing Clinical
Pathways
Appropriate feedback
and maintenance
plan
As low risk +
Referral to smoking
cessation services,
Obesity
management,
Diet and exercise
As moderate risk +
Pharmacological
intervention, GP
referral, intensive
lifestyle advice
Patient managed
according to existing
clinical pathways for
Diabetes,
Hypertension, CKD
through their GP
Patient exits the
Health Check
programme and is
followed up by their
GP
12
Figure 2: Patient flowchart for the NHS Health Check
Patient
details
Confirm eligibility and consent
Random
Finger-prick
blood test
Cholesterol
<6.5mmol/l
Cholesterol
6.5-7.4mmol/l
Cholesterol
≥7.5mmol/l
Blood
Pressure
≥180/110
Height and
weight,
calculate
BMI
≥160/100
≥140/90
<140/90
Repeat BP
after 48 hrs
BMI ≥30 or ≥27.5 if Asian origin
Diabetes and hypertension filter. Complete
initial NHS Health Check and recall patient
after 48 hours
Family
History
≥180/110
≥160/100
≥140/90
<140/90
Lifestyle
Fasting
Finger-prick
blood test
Smoking
Diet
FBG
≥11.1mmol/l
Physical
activity
FBG 5.6 to
<11.1mmol/l
FBG 3.0 to
5.6mmol/l
FBG
≤3.0mmol/l
Repeat test immediately
Appropriate advice and referral
Alcohol
Repeat
Blood
Pressure
Calculate
QRisk2
score
≥20%
10% to <20%
<10%
Advise to
see GP
within 48 hrs
Advise to
Advise to
Advise to
Advise
Lifestyle
see GP / PN
see GP / PN
see GP / PN
changes to
advice to
within 2
within 4
in 4 to 12
lifestyle to
maintain risk
weeksbe made on the
weeks
weeks with the greatest
reduce
risk according to the
Referral or advice should
basis of the risk factor
urgency
algorithm above
13
Figure 3: Patient Pathway for Diabetes and Hypertenion Case Finding
Follows on from Patient Pathway through the Health Check,
(see Figure 2)
10-year CVD risk score <20%
AND presence of one or more of the following risk factors
• BMI ≥ 30 (>27.5 all Asians)
• BP ≥ 140/90 but <160/100mmHg or isolated SBP or DBP ≥ 140mmHg and
90mmHg respectively
• Other risk factors for DM (1st degree relative with diabetes under age
60years, Gestational DM, PCOS, Long term steroid use)
Patient invited to return after 48 hours for Fasting
Blood Glucose test and repeat Blood pressure
Take patient’s fasting
blood glucose and
take blood pressure
FBG ≤3.0mmol/L
and
any blood pressure
Check analyser and retest, ensuring
correct amount of blood is used. If second
test ≤3.0mmol/l, advise patient to see GP
within 48 hours.
FBG ≥3.1mmol/L and ≤5.5mmol/l
and
BP now <140/90
Lifestyle advice and signposting (Figure 4),
FBG ≥5.6mmol/L and ≤11.0mmol/l
or
BP now <160/100
Lifestyle advice and advise patient to see
GP within three to four weeks
FBG ≥11.1mmol/L
and
any blood pressure
Check analyser and retest, repeating the
complete procedure including hand
washing (pharmacist and patient). If after
second test FBG≥11.1mmol/l, advise
patient to see GP within 48 hours.
Blood pressure ≥140/100 but
<160/100 and
FPG≤5.5mmol/l
Lifestyle advice and advise patient to see
GP within 12 weeks
Blood pressure ≥160/100
and
FPG≤11.0mmol/l
Lifestyle advice and advise patient to see
GP within two weeks
Blood pressure ≥180/100
and
FPG≤11.0mmol/l
Advise patient to see GP within 48 hours.
14
Figure 4: Pathway describing Lifestyle Advice
All individuals, irrespective of their CVD risk score should be offered tailored lifestyle advice
and signposting to relevant services for further guidance and support with maintaining a
healthy lifestyle. This diagram illustrates examples of specific lifestyle advice to be offered
to individuals, according to the presence of risk factors
If Current Smoker
• Explain to individuals that smoking doubles the risk of developing CVD
• Offer discussion with on-site Level 2 smoking advisor and referral to smoking
cessation services for ongoing support and help with stopping smoking
If Sedentary
Lifestyle
• Advice on the health benefits of keeping active
• Encouraging individuals to participate in at least 30 minutes of moderate
physical activity, on most days of the week
• Moderate physical activity means any form of exercise that gets you warm,
mildly out of breath, and mildy sweaty, e.g. brisk walking, jogging, cycling,
swimming
• Provide information on how individuals can increase their physical activity,
local fitness centres, group activities
Healthy Eating
&
Dietary Advice
Where BMI > 25
• Healthy eating will help to reduce weight and cholesterol levels.
• Providing information on what a healthy diet means (described below)
• At least 5 portions of fruit and vegetables daily (includes fresh, frozen,
canned and dried produce)
• The bulk of most meals should be starch based foods, e.g. cereals,
wholegrain breads, potatoes, rice, pasta
• Reducing intake of fatty foods, e.g. fatty meats, cheese, butter, full-fat
milk, cream, fried food. Switching to low fat, mono- or poly-unsaturated
spreads
• Include 2-3 portions of fish per week, at least one of which being ‘oily’ fish,
e.g. herring, mackerel, sardine, kippers, salmon, fresh tuna
• Reducing salt to no more than 6 grams daily
• If you eat meat, choose lean meat or poultry
• Use sunflower, olive or rapeseed oil for frying
• Reducing alcohol intake to no more than 21 units for men and 14 units for
women per week
• General advise on healthy eating (see box above)
• Referral to the Exercise on Referral scheme (EoR) with patient consent
• EoR referral criteria (following must be present to be included into the
scheme): Obesity (BMI > 25), CVD, Diabetes mellitus, Depression
(mild/moderate), Chronic respiratory disease, Musculoskeletal
injuries/disorders (must be referred to physiotherapist first)
If high
Cholesterol
(> 5.0 < 7.0
mmol/L)
• Reducing cholesterol levels will help to reduce ones risk of developing CVD
(See box for dietary advice to help reduce cholesterol levels)
Personalised
support
Personalised support across a range of lifestyle and health topics will be
available via the Health Trainers programme from January 2010. There will be
a specific referral mechanism and criteria for accessing the health trainers,
which will be disseminated to participating community pharmacies once
available.
15
5. Service Delivery
5.1 All screening and measurements undertaken as part of the Health Check will be performed by an
accredited pharmacist.
5.2 All lifestyle advice, signposting and referral following the Health Check will be performed by an
accredited pharmacist.
5.3 This enhanced service will only be commissioned from pharmacies providing the full range of Essential
Services as defined by the Pharmacy Contract.
5.4 All pharmacies providing this service should operate a 6-day opening policy (minimum Monday to Friday
with extended hours beyond 5.00pm and Saturday morning), with an accredited pharmacist available at
all times during these opening hours. (Exceptions to the 6-day opening policy will only be considered
where there is no pharmacy available locally that our patients can access).
5.5 Indemnity
Pharmacy providers must ensure that appropriate professional indemnity cover is in place.
The Service Provider will operate in accordance with all Acts of Parliament, statutory regulations
or other such laws, recommendations, guidance or practices as may affect the provision of
services specified under the Agreement.
Any litigation resulting from an accident or negligence on behalf of the Provider is the responsibility
of the Provider who will meet the costs and any claims for compensation, at no cost to the IPCT.
5.6 Pharmacy providers must adhere to the quality standards and guidelines of their professional body.
5.7 The pharmacy contractor has a duty to ensure that pharmacists involved in the provision of the service
have relevant knowledge and are appropriately trained in the operation of the service as demonstrated
through Continuing Professional Development (CPD) and Personal Development Plans (PDP). The PCT
will monitor this as part of the Contract and Performance management process.
5.8 Pharmacies must maintain and refer to a set of Standard Operating Procedures (SOPs) to cover all the
processes involved in the Health Check scheme. The SOPs should be readily available to and
understood by all staff involved in the scheme. (Refer to Standard Operating Procedures manual,
provided by Islington PCT).
5.9 The pharmacy contractor has a duty to ensure that pharmacists involved in the provision of the service
are aware of and operate within locally agreed protocols and within the scope of the services set out in
this specification.
5.10
The pharmacy must have adequate facilities and procedures for correct hand washing techniques.
Alcohol gel may be used up to five times before washing unless the hands are visibly soiled.
5.11
The pharmacy must allocate a safe place to store equipment and returns and sharps for safe onward
disposal. The storage containers provided by the PCT commissioned clinical waste disposal service
will be used to store used equipment.
5.12
The pharmacy should clearly display the NHS Islington Health Checks publicity materials and logo,
indicating participation in the service. These materials will be provided by NHS Islington. The
pharmacy will be required to provide dedicated window space for a window poster to advertise the
availability of the service from that pharmacy.
5.13
The pharmacy contractor should ensure that pharmacists adhere to infection control policies and
procedures, and ensure that all members of staff involved in the delivery of the service are aware of
infection control requirements. The pharmacists should be aware of the risk associated with the
handling of used equipment and the correct procedures used to minimise those risks. A needle stick
injury procedure and infection control policy should be in place. (Refer to Standard Operating
Procedures manual, provided by Islington PCT).
16
5.14
Pharmacists must share relevant information with other health care professionals and agencies, in
line with locally determined confidentiality arrangements.
5.15
Pharmacists must ensure that any incidents relating to provision of the service will be reported using
their standard incident reporting form and a copy of the incident form will be sent to the PCT within 7
working days of the incident.
6. Referral, Access and Acceptance Criteria
5.16
Geographic coverage and acceptance criteria
All Islington residents in the target population are eligible for this service. Individuals who are resident in
Islington and identified via this scheme as not being registered with any GP should be given clear
information by the pharmacist explaining how to register. These individuals should be actively encouraged to
register.
Individuals who are not Islington residents will only be eligible for a Health Check in Islington community
pharmacies if they are registered with an Islington GP.
Pharmacies contracted to provide this service will accept all patients who meet the eligibility criteria. The
service will not discriminate on the grounds of ethnicity, sexual orientation or disability. The service will
endeavour to meet the needs of patients that have visual or hearing impairment.
5.17
Opportunistic identification and sources of referral
Participating pharmacists should identify and invite individuals to take part in a Health Check on an
opportunistic basis. GPs and other health care professionals are also able to refer patients to the community
pharmacy for a Health Check.
Individuals will be able to self-refer into the community pharmacy for a Health Check.
5.18
Onward referral to other services, including General Practice
All individuals will be given a print-out of the information gathered during the assessment, including
measurements, blood tests results and calculated risk scores. Individuals who are advised to see their GP
will also be advised to take this print out with them to their GP appointment.
Where onward referral to the patient’s GP is indicated, this will be done electronically, via the dedicated
health check software package. A clinical report, giving the results of the assessment and indicating the
reason for referral, will be sent via fax to the patient’s GP. Data items include in the clinical report e.g.
smoking status, BP etc. will be READ coded by the software provided to facilitate entry into the patient’s
clinical record by the general practice. Information regarding the outcome of the assessment for individuals
who do not require GP referral will also be transferred to general practice using the same secure method.
The PCT will provide participating pharmacies with patient information regarding local services and sources
of further information and support with management CVD risk factors.
Referral to smoking cessation services: Referral to stop smoking services should be discussed and
offered to all current smokers. The pharmacy will have an on-site Level 2 smoking cessation advisor who
will mediate this service. NHS Islington will monitor the number of referrals to smoking cessation services.
Exercise on referral: Individual who meet the specified criteria described below, should be offered a referral
to the Exercise on Referral service. Referrals should be made via fax using the dedicated referral form?
Health trainers: Further information will be provided to participating pharmacies once this new service is
operational and referral mechanisms and eligibility criteria have been clarified and established.
5.19
Response times
The Health Check programme is a while-you-wait service so customers will leave the community pharmacy
with their results, wherever practicable. However, there may be some occasions when the dispensing activity
is high where patients may be asked to return at a later time. In such cases the Pharmacist must be present
at the agreed time.
17
7. Equipment
The pharmacy is required to have the following equipment. The equipment will be provided either by
the PCT or contracted equipment providers, unless otherwise stated:
“Health Check Kit” provided by NHS Islington
The equipment listed below will be provided to pharmacies for the purpose of undertaking NHS Health
Checks. All equipment provided will remain the property of NHS Islington and may be withdrawn in the case
of non-compliance with this Service Level Agreement.
“Cardiopod” Touch Screen computer
HP Officejet Pro 8000 inkjet printer and cartridges subject to reasonable usage
Cholestech LDX analyser including power supply, analyser, optics check cassette, user manual, training
video
TC/HDL/GLU reagent cassettes
MAC internal quality controls Level 1 & 2
External Accredited Quality Assurance scheme (6 samples per year)
Heparinised glass tubes and plungers 40 μl
Approved Auto Blood Pressure Unit, TM 2655P or better
Blood Pressure Cuff with both Small and Large cuffs
200kg scales UC – 321PL
Height measurement rod
All warranties on equipment provided.
Branded folders, information leaflets and signposting information regarding local services; publicity and
promotional materials
Additional “Health Check Kit” provided by Pharmacies
Unistik Extra 3 or Haemolance Lancets
Swabs, disposable gloves, plasters, soap dispensers
7.1
The PCT will be responsible for provision of all necessary “Health Check Kit “(as defined above),
except where it is indicated that the pharmacy will be responsible for providing equipment.
7.2
The Service Provider must only use the approved equipment provided to them by IPCT for delivery
of the NHS Health Checks service.
7.3
The pharmacy provider will be responsible for the maintenance and care of all necessary “Health
Check Kit”, including compliance with all warranties.
7.4
All equipment used in the NHS Health Check must comply with MHRA regulations where applicable.
7.5
The pharmacy will ensure that all equipment used is working properly and that the appropriate
internal quality control and external quality assurance tests, and calibration, are carried out as
18
described in the Standard Operating Procedure (SOP) manuals and in accordance with the training
received.
7.6
The provision of disposables and waste management, including single-use consumables, must
comply with environmental regulations and infection control policies.
7.7
The pharmacy will be responsible for ordering ongoing reagent cassettes, heparinised glass tubes,
branded folders and information leaflets from the PCT.
7.8
The pharmacy will be responsible for providing and maintaining a suitable N3 broadband connection
in the consultation room.
7.9
The equipment may not be used for private services paid for by patients.
7.10
The pharmacy will adhere to PCT guidance on delivery of the NHS Health Checks.
8. Patient and Carer Information
8.1
Wheelchair access
Wheelchair and disabled access is provided at Community Pharmacies.
8.2
Access to information for individuals with visual or hearing impairments
Audio and Braille versions of any materials provided will not be available at the launch of the
programme. It is anticipated that these materials will become available over time. Initially,
pharmacists are asked to assist individuals who have such impairments.
8.3
Languages other than English
Over time, patient information materials to support delivery of the Health Check programme will be
developed in a range of community languages. Initially, where material is only available in English,
pharmacists will be expected to assist individuals for whom English is a second language.
9. Quality Assurance
9.1
Point of Care Testing (POCT)
Point of Care Testing (POCT, also referred to as Near Patient Testing or NPT) entails the use of analytical
equipment, such as patient test kits and analysers, by a trained healthcare operator near to the patient,
instead of in a clinical laboratory.
Pharmacists will be trained in the use of the POCT equipment, and only those individuals who have had the
relevant training will be able to use the equipment.
Pharmacies commissioned to provide the Health Check service will all be issued with a manual outlining the
Standard Operating Procedures (SOP) for all of the equipment supplied.
Training on the use of the POCT equipment will be provided by NHS Islington by a competent trainer. All
participating pharmacists will need to demonstrate completion of this training and competence in the use of
the POCT equipment, prior to the equipment being put in place.
All POCT equipment will be calibrated in accordance with the manufacturer’s guidance.
9.2
Quality Control on the blood analyser machine
Internal quality control (IQC): The Optics Check Cassette, used to verify the optical system of the analyser,
must be run once daily prior to testing patient samples.
External quality control (EQA) (arrangements tbc): A QA solution sample will be sent to the pharmacy for
testing on a monthly basis. The results must lie within the established ranges before the equipment can be
used to perform tests on individuals accessing the service. Pharmacists are required to record the results of
these monthly QC checks, according to the protocol described in the SOPS manual.
19
IQC and EQA requirements are mandatory. Where pharmacies do not adhere to IQC/EQA requirements the
service will be withdrawn.
9.3
Quality Control on the blood pressure equipment and weighing scales
Pharmacy providers are responsible for ensuring that blood pressure equipment and weighing scales are
correctly calibrated at all times. Where there is doubt about the accuracy of the equipment no NHS Health
Checks should be undertaken until further advice sought from the manufacturer or NHS Islington.
10. Marketing and Publicity
10.1
Within participating pharmacies
All pharmacies offering the NHS Health Check should display the publicity materials provided by NHS
Islington. This includes display of the NHS Health Checks poster in a visible location in the pharmacy
window. Information leaflets regarding the Health Checks programme will also be provided and should be
readily accessible to individuals using the pharmacy service. Pharmacists are expected to identify and
pursue opportunities to promote the Health Checks programme and proactively invite individuals to take part
in the programme.
10.2
General marketing
NHS Islington will support the launch and ongoing delivery of the Health Checks programme in pharmacy
through a series of advertising and marketing activities, in order to maximise uptake.
11. Activity
11.1
Activity Record and Invoices
The dedicated Telehealth Cardipod system supports automatic recording of all Health Check activity
undertaken by individual pharmacists. Each new patient Health Check, as well as further assessments (BP
and FPG) undertaken at recall visits, will be captured via the Cardiopod system on a secure server. This
information will be accessible to the PCT, and will be used to track activity within individual pharmacies as
the basis for payment.
Participating pharmacists are required to submit an activity log (printed from the Cardiopod) together with a
copy of the Internal Quality Control log and an invoice on a quarterly basis (see section 13, Payments)
12. Payments to pharmacies
12.1 Upfront payments
The Service Provider will receive locum cover costs at a rate of £230/full day (£115 half day) to attend the
Health Check training programme, run by NHS Islington and any subsequent update training. Costs will be
reimbursed for per pharmacist to attend this training. If a pharmacist who is trained to deliver the Health
Check service leaves the service provider permanently within 2 years of undergoing the initial training, the
service will be suspended until such time as a replacement is accredited. NHS Islington will endeavour to
arrange a place on the next available course, although this is not guaranteed.
Pharmacies will also receive an annual payment of £100 payable quarterly to cover the provision of gloves,
swabs, plasters and lancets. Pharmacists will need to include a claim for £25 to cover these costs on each
quarterly invoice/claim form.
12.2
Ongoing payments
Pharmacists will be paid £28 for every Health Check completed. An additional payment of £28 will be made
for those eligible patients who are recalled to pharmacy for a repeat BP and fasting plasma glucose test. No
additional payments will be made if a patient is recalled to the pharmacy but does not attend.
12.3
Printer consumables
Replacement cartridges for the printer used for NHS Health Checks will be reimbursed subject to reasonable
use.
20
12.4
Payment schedule
Payments will be made quarterly on receipt of an activity log printed from the Cardiopod system
accompanied by a copy of the Internal Quality Control log and invoice or claim form.
Documentation required for payment should be submitted by the 5th day of January, April, July and October.
13. Information Governance
13.1
Patient Consent
Patients must give signed specific consent when entering into the programme. Consent is required:

To inform the patient’s GP of the test results, and any other relevant information.

To allow the pharmacy and NHS Islington to contact the patient and patient’s GP for follow up
purposes.

To provide anonymised data to NHS Islington for the purposes of service monitoring, evaluation,
publication or research.

To take a blood sample.
13.2
Confidentiality
“The public expects pharmacists and their staff to respect and protect confidentiality. This duty extends to
any information relating to an individual, which pharmacists or their staff acquire in the course of their
professional activities. Confidential information includes personal details and medication, both prescribed
and not prescribed.” 16
Any explicit request by a patient that information should not be disclosed to particular people, or indeed to
any third party, must be respected save in the most exceptional circumstances, for example where the
health, safety or welfare of the patient or someone other than the patient would otherwise be at serious
risk.17
All data relating to individuals who receive a Health Check will be held on a secure server, managed by
Islington PCT. Pharmacists agree to share information with NHS Islington via remote access.
Pharmacists will have a private room within the premises that can be used for consultations.
Pharmacies will ensure that all electronic and paper copies of patient records/data held by them relating to
this service are held in a secure manner that makes them inaccessible to anyone else except accredited
pharmacists.
Pharmacists are required to keep any written patient data in respect of this enhanced service in a locked
drawer/cupboard.
Pharmacies will have N3 broadband connection in consultation room and will transmit information in
accordance with NHS Islington Information Governance guidelines.
All data will be submitted according to the PCT guidelines.
Pharmacists are required to keep a record of clinically significant information from this programme.
13.3
Provision of information
Pharmacies will provide patient results to GP surgeries and NHS Islington in accordance with patient
consent.
16
Medicines, Ethics and Practice - A Guide for Pharmacists. No 28. July 2006; Code of Ethics and
Professional Standards: Part 2: Standards of Professional Performance, Section C: Confidentiality
17 The General Medical Council (GMC) Statement on the duty of confidentiality
21
Pharmacies will provide patient results to the Health Trainers once the health trainer programme is
implemented, in accordance with patient consent.
13.4
Protection of Information
Service users will be provided with an ID number at their first screening consultation. If an individual is
recalled to pharmacy, their existing data will only be retrieved on completion of the following fields:
 Name
 Surname
 Address
 Postcode
 Date of Birth
 Patient Identification Number (PIN) (issued at the first screening check)
14. Monitoring, Evaluation and Service Improvement
In line with the Enhanced Service monitoring undertaken by NHS Islington, an indicative quarterly target of
50 consultations by the provider pharmacy has been set by the PCT. The PCT will closely monitor the
activity of the provider pharmacy and reserves the right to withdraw the service and remove any “Health
Check Kit” (where it has been provided by the PCT) should this target not be achieved.
The PCT reserves the right to withdraw this enhanced service immediately if the pharmacy is found not to be
meeting its requirements for provision of the Essential Services in Pharmacy Contract after the SLA has
commenced.
All participating pharmacies will be expected to participate and cooperate with any future audits, surveys or
service evaluations of the Health Checks in Community Pharmacy programme by NHS Islington.
This service specification will be revised regularly according to need & changing environmental factors,
including nationally mandated changes to the NHS Health Checks programme.
15. Duration and Annual review
This agreement is intended to remain in place, subject to compliance with sections 1 to 14, from launch in
early 2010/11 to March 31st 2012
This service will be reviewed jointly with the pharmacy provider within 6 months of commencement at
annually thereafter.
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