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 National Health Service (NHS) Health Check (DHC) to the standard face-to-face NHS Health Check (F2F). Participants and setting A random sample of 9000 patients aged 40-74 eligible for an NHS Health Check in Southwark, England, between January and April 2023. Intervention and 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 an F2F invitation. Those invited to DHC were able to choose F2F if they preferred. Outcomes The primary outcome was the 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 who moved away or died, the DHC uptake to the health assessment section was 21% (1189/5705), with a further 3% (198/5705) choosing F2F, compared with 11% (305/2900) for F2F completion (p<0.001). The DHC uptake was lower among those from Black (14%) and Mixed (13%) compared with 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 among F2F users (p<0.001). The estimated total management and operation costs for F2F were 154.80 pound per user, compared with total management and operation costs for DHC of 68.48 pound per user for health assessment only, 134.46 pound including the support section and 1479.01 pound 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. Registration This study was registered on the Open Science Framework: https://osf.io/y87zt.https://osf.io/y87zt