Feature Too Much Medicine

Where’s the evidence for NHS health checks?

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5834 (Published 02 October 2013) Cite this as: BMJ 2013;347:f5834
  1. Margaret McCartney, general practitioner
  1. 1Glasgow, UK
  1. margaret{at}margaretmccartney.com

The NHS in England must now offer health checks to swathes of the adult population. But is this programme really clinically or cost effective? asks Margaret McCartney

Back in January 2008, the then prime minister, Gordon Brown, announced “everyone in England will have access to the right preventative health check-up . . . there will soon be check-ups on offer to monitor for heart disease, strokes, diabetes, and kidney disease.” Brown went further, pledging a national screening committee, an independent clinical body, that “will look at the evidence and advise on what additional screening procedures would be genuinely useful in detecting other conditions.”1

Today these “check-ups” have arrived in the form of NHS health checks, available to all 40-74 year olds in England every five years. But does this policy, which every local authority is mandated by law to provide,2 have a sound basis in evidence?

The health checks consist of an appointment with a healthcare professional at which people are asked about their family history and lifestyle and have their body mass index, blood pressure, and cholesterol concentration measured. Further investigations may then follow.

In July 2013, Public Health England said that by systematically targeting hypertension, smoking, high cholesterol, obesity, diet, physical activity, and alcohol intake the health check programme provides a “fantastic opportunity” to help “prevent 1600 heart attacks yearly, saving at least 650 lives; prevent over 4000 people from developing diabetes; detect at least 20 000 cases of diabetes or kidney disease earlier.”3 But, although there is clear evidence that advice to stop smoking has a beneficial effect,4 what about the rest of the programme?

Untested

Public Health England says that implementing the programme “in the absence of direct randomised controlled trial …

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