Quality standard

Quality statement 1: Advice for adults during NHS Health Checks

Quality statement 1: Advice for adults during NHS Health Checks

Quality statement

Adults having their NHS Health Check are given brief advice about how to be more physically active.

Rationale

The primary care setting provides opportunities to implement the principles of the Making Every Contact Count initiative by enabling healthcare professionals to deliver lifestyle advice as a preventative measure. The NHS Health Check aims to reduce the risk of a number of conditions that physical activity can help to prevent. The NHS Health Check gives healthcare professionals a good opportunity to give brief advice to adults on a one‑to‑one basis about the benefits of physical activity and of using local physical activity services such as walking groups. This should therefore lead to an increase in physical activity levels.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that adults who are having their NHS Health Check are given brief advice about how to be more physically active.

Data source: Evidence can be collected from information recorded locally by healthcare professionals and provider organisations, for example, local protocols on providing advice at NHS Health Checks.

Process

a) Proportion of adults having their NHS Health Check whose records state that they have been given brief advice about how to be more physically active.

Numerator – the number in the denominator whose records state that they have been given brief advice about how to be more physically active as part of their NHS Health Check.

Denominator – the number of adults having their NHS Health Check.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. Data on the number of people receiving an NHS Health Check in England is published on the OHID NHS Health Check profile.

b) Proportion of adults having their NHS Health Check who are identified as needing to do more physical activity after receiving brief advice and whose records state that they have been signposted to physical activity services.

Numerator – the number in the denominator whose records state that they have been signposted to physical activity services as part of their NHS Health Check.

Denominator – the number of adults having their NHS Health Check who are identified as needing to do more physical activity after receiving brief advice.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. Data on the number of people receiving an NHS Health Check in England is published on the OHID NHS Health Check profile.

c) Proportion of adults who have had an NHS Health Check and been signposted to physical activity services whose outcome is recorded.

Numerator – the number in the denominator whose outcome is recorded.

Denominator – the number of adults who have had their NHS Health Check and been signposted to physical activity services.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. Data on the number of people receiving an NHS Health Check in England is published on the OHID NHS Health Check profile.

Outcome

Proportion of adults meeting the recommendations in the UK Chief Medical Officers' physical activity guidelines.

Numerator – the number in the denominator who meet the recommendations in the UK Chief Medical Officers' physical activity guidelines.

Denominator – the number of adults.

Data source: Data is presented from NHS England's Health Survey for England on physical activity in young people and adults aged 16 and over. Sport England's Active Lives Adult Survey publishes data on physical activity in adults aged 19 and over; data from this survey are also presented on the OHID physical activity tool as 'percentage of physically active adults', which is included in the Public Health Outcomes Framework (indicator C17a).

What the quality statement means for different audiences

Service providers (primary care services such as GP surgeries and pharmacies) ensure that their staff are trained and competent to give adults who are having their NHS Health Check brief advice about how to be more physically active, and in signposting adults to physical activity services.

Healthcare professionals (such as GPs and pharmacists) give adults who are having their NHS Health Check brief advice about how to be more physically active, and signpost them to physical activity services.

Commissioners ensure that they commission services in which NHS Health Checks include giving brief advice to adults about physical activity and signposting them to physical activity services.

Adults having their NHS Health Check are given advice and information about how to be more physically active and what services are available locally. The NHS Health Check is a national programme to identify people at risk of heart disease, stroke, diabetes, kidney disease and certain types of dementia.

Definitions of terms used in this quality statement

Brief advice

Giving brief advice or intervention involves oral discussion, negotiation or encouragement, with or without written or other support or follow‑up. It may also involve a referral for further interventions, directing people to other services or more intensive support. In this context, if the person is already achieving the UK physical activity guidelines the advice should focus on sustaining this by offering praise and encouragement. Brief advice can be delivered by anyone who is trained in the necessary skills and knowledge. These interventions typically take no more than a few minutes for basic advice. [Adapted from NICE's guideline on physical activity: brief advice for adults in primary care, NICE's guideline on behaviour change: individual approaches, and expert opinion]

NHS Health Check

The NHS Health Check aims to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia. Everyone between the ages of 40 and 74, who have not already been diagnosed with 1 of these conditions will be invited (once every 5 years) to have a check to assess their risk of heart disease, stroke, kidney disease and diabetes. People attending NHS Health Checks will have their risk assessed through a combination of their personal details, family history of illness, smoking, alcohol consumption, physical activity, BMI, blood pressure and cholesterol. They should be given support and advice to help them reduce or manage their risk. [Adapted from the NHS Health Check competency framework and NICE local government briefing 15]

Signposting to physical activity services

Signposting describes the process for directing a person to a suitable local service. As part of an NHS Health Check, a person may be signposted or directed to the local gym or walking group, for example, or referred to lifestyle or clinical services. This aims to help guide people to local services that are appropriate for them. This will encourage people to use the services and support them in making lifestyle changes. [Adapted from the NHS Health Check best practice guidance]

UK physical activity guidelines

The current recommendations for physical activity from the UK Chief Medical Officers state the following:

  • All adults aged 19 years and over should aim to be active daily.

  • Over a week, this should add up to at least 150 minutes (2.5 hours) of moderate intensity physical activity.

  • Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity; or even shorter durations of very vigorous intensity activity; or a combination of moderate, vigorous and very vigorous intensity activity.

  • All adults should also undertake physical activity to develop or maintain strength in the major muscle groups on at least 2 days a week. For older adults (65 years and over) they should also undertake activities aimed at improving or maintaining balance and flexibility on at least 2 days a week. These could be combined with sessions involving moderate aerobic activity or could be additional sessions aimed specifically at these components of fitness.

  • Adults should aim to minimise the amount of time spent being sedentary, and when physically possible should break up long periods of inactivity with at least light physical activity (or for older adults, at least with standing).

[UK Chief Medical Officers' physical activity guidelines]

Equality and diversity considerations

When advising adults to become more physically active and signposting them to physical activity services, healthcare professionals should take into account gender, the needs of people from different socioeconomic backgrounds and cultures, and the needs of adults with mental health conditions and learning or physical disabilities. When providing written information, healthcare professionals should ensure that it is accessible to people with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English.